As important as medicine has always been to me, I
fairly suddenly decided that I needed to do more traveling, always a desire that
I had neglected. My health is excellent, but at the age of 53 I also realized
that I was not going to live forever, and my state of good health in the future,
as with everyone else on this planet, could never be assured or guaranteed for
any period of time. My kind friends might say that I was undergoing a mid-life
crisis, while my less loving associates would surely label it a post-mid-life
crisis. My first destination was Colombia, South America. More specifically,
Cali, Colombia. Yes, that's right, Cali. The same city that is known primarily
in the United States as the number one city in the world for kidnapping gringos
for profit and/or fun. Also, the same city that has cocaine literally sustaining
it economically while at the same time destroying its very essence.
There were
many reasons I chose this destination, but they are not really pertinent to this
newsletter. Suffice it to say that every member of my immediate family, as well
as numerous close friends, exhorted me to control my seeming sudden psychosis
and go elsewhere or stay at home. I ignored all of these requests as gently and
firmly as I could, agreeing to be fully appreciative of whatever prayers and
novenas they chose to say on behalf of my welfare and safety.
Colombia is truly a physically beautiful country,
populated by
persons possessed with predominantly good hearts and souls. I
must haven taken hundreds of cab rides, and I never encountered one cabbie who
wanted to negotiate for extra money. To the contrary, they followed strictly
their meters. On more than one occasion, a cab driver called me back to the cab
to give me a few hundred pesos (ten to fifteen cents) that I did not realize was
owed to me. However, as advertised, it is not really very safe, and an outsider
in Cali has to be steered to a limited number of locations where security is
maintained at all times by uniformed
guards casually strolling their beats with machine guns in hand. While this was
disconcerting at first, it later proved to be much more a comforting than a
horrifying sight.
It was actually on my fourth (yes, fourth) visit to
Cali that my emotions were ambushed as they have never been before. My office
manager had been traveling with me on all of these visits as
well, and we had decided on an earlier visit to try to establish a clinic in
Cali that could easily administer intravenous vitamin C for a wide range of
conditions. As a result, we had gradually been
bringing with us small amounts of vitamin C powder that simply was not available
there. We wanted to be equipped to treat ourselves as well as others.
Then the Unpredictable Hit
I had already developed a good friendship with a
lovely Latin gal from Cali. She gradually came to appreciate the potential that
vitamin C had for treating a wide range of medical conditions, as she was quite
fluent in English as well as her native Spanish. Because of this, she had
discussed what I did with her mother at some length. Five days before I last
left Cali, my friend asked me if I could try to help treat the daughter of her
mother's best friend. I agreed readily, my office manager fixed up a bag of
roughly 90
grams of sodium ascorbate in 500 cc of D5W, and away I went with my friend in
one of Call's some 15,000 ever-present taxicabs.
What I saw when I arrived I will never forget.
Profound poverty as I had never directly witnessed before. Watching a National
Geographic television special and actually experiencing third world poverty are
two very different things. I was initially afraid to get out of the cab, but my
friend assured me that I would be safe, and I had faith in her judgment. When we
finally gained access to my future patient through fairly secure but old rusted
security gates, we had been eyed more than casually quite a bit by many curious
neighbors.
My Patient
When I first saw my patient, a beautiful and petite,
totally bedridden, 30 year-old Latina, I had to quickly leave the room as tears
started welling up in my eyes. After practicing medicine
for nearly 30 years and sadly watching numerous patients die, my emotions were
as poorly composed as they had ever been in my life. My friend looked a little
confused and asked me what the matter was. I simply told her that this patient
was nearly dead from pulmonary embolism, and the moment of death could occur at
any time. She was not comatose, but she was very weak with very labored
breathing. At any moment another blood clot could break away from her tender and
swollen legs and she would be another victim of traditional medicine. She was on
Coumadin and was well anticoagulated. However, after having fever every day for
2 months in the hospital, the doctors basically gave up and sent her home to
die.
Traditional Medicine in Third World Parrots the US Medicine
I suppose in the United States, they might have
added heparin and let her die in the hospital rather than at home, but other
than that, the care would have differed little. Within certain boundaries
limited primarily by lack of money, the traditional medicine offered in third
world countries closely parrots the traditional medicine practiced in the United
States. After reviewing what limited medical information was available, my
friend helped me in my translation of the medical records and my questioning of
the patient. It appeared the patient had a mixed collagen vascular disease with
Raynaud's
phenomenon. At some point she developed deep venous thrombosis with pulmonary
emboli. She also had a heart scan that indicated some degree of heart attack or
other form of heart damage had
taken place as well. Furthermore, she had a root canal in her front tooth and
several of the largest mercury amalgam fillings in her molars that I had ever
seen.
Even as a physician who has saved many lives and
perhaps lost more patients than he cares to admit, I have always hated being put
in the position of playing God with anybody's life. However, certain
circumstances sometimes dictate that whatever decision you make, proactive or
otherwise, is going to save, possibly kill, or even
have no effect on the patient.
Vitamin C neutralizes Coumadin (a drug that thins
the blood to help prevent existing clots from propagating or new clots from
developing). While I was certain that vitamin C would stimulate her immune
system and normally promptly improve her condition, I had always been trained to
never do anything to neutralize the blood thinning effect of Coumadin in a
patient with venous thromboses that could be threatening to travel to her lungs
at any time and kill her. However, Coumadin just stabilizes blood clots, and the
thinking (and hoping) is that the patient will then slowly stabilize and very
gradually dissolve the blood clots without dislodging them suddenly in large
obstructive clumps into the lungs via the venous blood system.
Vitamin C, on the other hand, also promptly
stabilizes and stops inflammation whenever a high enough concentration of
it can be delivered. My clinical and scientific feeling was that ongoing,
rampant inflammation was probably this patient's greatest threat to developing
larger and potentially fatal blood clots that
could possibly dislodge to her lungs and kill her.
Divine Intervention Helped
Somewhat reluctantly, but with guarded optimism, I
started the IV. Divine intervention must have helped, because she had some of
the poorest veins I had ever seen, yet the needle somehow got
into one on the first stick. She hardly flinched.
My friend and I remained during the two to three
hour IV infusion, which was fairly uneventful. The patient had not eaten solid
food for a long time, sustaining herself primarily on Ensure. She could not sit
up in bed without a large amount of help, and when she stood to urinate, family
members had to support her entire weight and let her urinate directly into a pan
at her feet.
She was wearing tattered pajamas.
I had never given this dose of vitamin C to anyone
on Coumadin, so I had to know just how drastically this would affect her blood
thinning. I requested that the family get another blood test the next morning.
They said no problem, but that the patient would have to get on a bus and sit
around in a clinic for several hours. I said to get the blood drawn at home, but
they said that
would cost 30,000 pesos (about 12 to 13 dollars USD). I supplied this money to
them since the manipulation of the patient might have just killed her. The lab
result the next day did verify that
much of the anticoagulation had been reversed by the vitamin C, so I temporarily
(without further laboratory testing) increased her Coumadin intake for the next
few days.
Our Patient Takes a Shower
The next afternoon my friend and I returned to give
another IV. I cried again, but this time for joy. Our patient was sitting up in
bed, wearing normal and pretty clothes, combing her hair, and able to rapidly
walk across the room to go to the bathroom. She had just come back from taking a
shower. Her mother said she was free of fever for the first time in two months.
She also ate a normal and well-balanced meal for the first time in recent
memory. She also complained bitterly about being stuck again for the IV, a sure
sign of recovery.
The third IV day was a plateau day for improvement,
and the fourth day the patient was grinning with a smile that seemed to extend
from one ear to the other. Her soreness in her legs had
steadily resolved from the time of the first IV. I carefully went over
nutrition, the urgent need for amalgam and root canal removal as soon as she is
eventually taken off of Coumadin by her doctors, and I left her with enough
vitamin C powder for several months of supplementation at about 2,000 mg daily,
a practical although suboptimal dose. I advised the family to keep her on the
dose of Coumadin that she had been on when I first saw her and to check her
blood thinning in another week. I also gave advice on some simple and
inexpensive other forms of vitamin and mineral supplementation that could be
obtained on a repeated basis in the drugstores in their country.
Fiesta
On the last day, after the fourth bag of vitamin C
by vein, the patient's mother treated my friend and I to a traditional Colombian
Sunday afternoon feast. Rarely have I eaten so well. I couldn't
begin to describe everything that was in it, except that it was the best meal I
had eaten in all four of my visits to Cali. Along with her daughter's positive
clinical response, it represented more than a
generous payment to me for the efforts of my friend and I for the treatments we
had given.
Although the patient has continued to improve, I
have no doubts that another 7 to 10 days of intravenous vitamin C would have
been greatly appreciated by this patient's healing body and further accelerated
her recovery from this acute/chronic health crisis.
An Important Addendum
I am NOT advocating ever treating established deep venous
thrombosis with only vitamin C. Heparin and/or Coumadin anticoagulation should
still be used in their usual protocols. However, I would advise strongly
considering treating the patient
vigorously with oral and intravenous vitamin C as well, making sure by frequent
blood testing that the prothrombin time and INR are in the established
acceptable ranges of anticoagulation for this potentially and often lethal
condition.
