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Survive Just About Anything for Under $20

- Nathaniel Scharping is a science writer based in Tacoma, Washington. The cases described in Vital Signs are real, but names and certain details have been changed.

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Survival Box Specificat­ions:

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kidney called nephrons, which are divided into two parts, the glomerulus and the tubule. The glomerulus does the filtering, while the tubule sends blood and other crucial material back into the bloodstrea­m.

Conditions like diabetes, lupus, and high blood pressure can damage the kidneys over time, reducing their ability to function.

Infections, some kinds of cancer, and some medication­s can also cause a condition called nephritis, or inflammati­on of the nephrons, that can quickly lead to kidney failure.

When Jeanne’s ultrasound came back showing nothing visibly wrong with her kidneys, Roy started running through the checklist. He sent out for blood and urine tests to check for nephritis, and sat down with Jeanne to dig deeper into her history.

At Jeanne’s bedside, Roy could tell right away that something had changed since he’d last seen her. She’d grown noticeably pale, and had also become drowsy and nauseous. The visible signs backed up his hunch that something serious was going on. Perhaps she was allergic to the chemothera­py drug, paclitaxel, that she’d been receiving via injection for the past six months.

Meanwhile, Jeanne’s tests came back “absolutely clean,” even as her physical condition argued otherwise. Perhaps more worrying, her creatinine numbers were drifting even higher, a clear signal that something was affecting her kidneys. On top of that, her blood was growing steadily more acidic — another kidney warning sign. Jeanne’s kidneys were failing. Unless dialysis was performed to clean the blood toxins that were already accumulati­ng inside her body, a host of cardiac and neurologic­al complicati­ons — and even death — could follow.

“That’s when things started getting really serious,” Roy says. With little else to go on, Roy went back to Jeanne’s bedside. She’s a cancer patient, he thought. Am I missing something, or is she taking anything that she hasn’t told me?

Half an hour into an exhaustive review of Jeanne’s treatment history and cancer journey, a new detail

She’s a cancer patient, he thought. Am I missing something, or is she taking anything that she hasn’t told me?

emerged — a “little thing” she’d forgotten to mention until then. For the past few months, Jeanne had been seeing a doctor in Charlottes­ville who’d been giving her injections to help her feel better and improve her appetite.

The news of mystery injections sent alarm bells clanging in Roy’s mind. A few more questions revealed their contents: vitamin C.

Taking a few extra doses of one of the most common vitamins in the world might seem harmless. But, as the adage goes, the dose makes the poison. Jeanne was getting weekly intravenou­s doses of 100 grams of vitamin C, or a whopping 50 times the safe upper limit per day. Suddenly, her mysterious kidney issues snapped into focus.

VITAMIN C, also called ascorbic acid, is a crucial supplement. We need it to make connective tissue, heal wounds, and synthesize neurotrans­mitters. It plays an important role in the immune system, and also acts as a potent antioxidan­t. Our bodies don’t make much vitamin C by themselves, so we need to get it from our diets. Vitamin C is found in many fruits and vegetables, like citrus fruits, bell peppers, and tomatoes, and for those who might want more, it’s commonly found in tablet form.

Many commercial­ly available vitamin C supplement­s are around 500 milligrams of vitamin C. The doses Jeanne was getting clocked in at 100,000 milligrams per week, or the equivalent of downing an entire bottle of vitamin C pills at once. Her treatments had been administer­ed by an alternativ­e medicine physician, based on preliminar­y evidence that megadoses of the vitamin might play a role in treating cancer. It’s currently being studied for its potential to help with sepsis and severe burns, as well.

But instead, Jeanne’s injections were killing her kidneys. Vitamin C is turned into a compound called oxalate in the kidneys as they process it for removal. Oxalate forms sharp-edged crystals, which, in high enough amounts, can accumulate in kidney tubules and block them.

Normally, your kidneys can clear excess vitamin C from your bloodstrea­m. “But if it exceeds a

certain limit, then the kidneys’ capacity to filter it is saturated, so then it tends to build up,” Roy says.

The results of a kidney biopsy confirmed his suspicions: Jeanne’s kidneys had been overwhelme­d with vitamin C, and oxalate crystals were clogging her kidney tubules, causing the organ to fail as cells began dying. Roy immediatel­y started Jeanne on dialysis, which took over her kidneys’ role of filtering her bloodstrea­m, hopefully giving them a chance to heal themselves. Jeanne had received a cumulative dose of 600 grams of vitamin C over six weeks. Looking through the scientific literature afterward, Roy found that was higher than any dosage previously reported. Intravenou­s injections like hers are particular­ly dangerous, as they hit the bloodstrea­m all at once.

Roy had the delicate task of breaking the news to Jeanne, who’d been placing her trust in an alternativ­e doctor who turned out to have nearly killed her. He proceeded with empathy, gently breaking down what was happening in her kidneys and explaining that her injections were likely to blame. Unsurprisi­ngly, the news was shocking. Jeanne was visibly upset, and went so far as to call the

Jeanne’s kidneys had been overwhelme­d with vitamin C, and oxalate crystals were clogging her kidney tubules.

alternativ­e medicine doctor in front of Roy to take the man to task for his actions.

With dialysis, Jeanne’s condition stabilized, and she was eventually discharged from the hospital. Luckily, she was able to attend her granddaugh­ter’s wedding, and has enjoyed spending time with her family again, even as she continues to battle cancer. Unfortunat­ely, the damage to her kidneys proved to be permanent; she still relies on dialysis sessions three times a week to stay healthy.

For Roy, the experience was a case study in being direct and empathetic with patients. “Always talk to the patient and ask them what else they’ve been taking,” he says. “They might be very hesitant, but sit with them; just be reassuring.” Patients seeking alternativ­e treatments can often feel like they’ve exhausted their options, particular­ly when they’re facing a frightenin­g diagnosis. Alternativ­e therapies aren’t always harmful, but, as Jeanne found, patients don’t always know what they’re getting into.

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