Vitamin C Deficiency

choi

Lisa Sanders, Complicated Symptoms, Siple Solution. A Painful Bruise Wouldn’t Heal. It Took Several Hospital Visits to Discover Why. New York Times Magazine, Mar 4, 2018
https://www.nytimes.com/2018/02/ ... o-discover-why.html

Quote:

"She'd had her period for nearly a month now, the woman [the patient whose age this article did not say] said. That had never happened before. And, her daughter added, she had these weird dots on her legs. They just popped up a few weeks before. [first-year resident Vivek] Naranbhai looked carefully at the mother's legs. They were covered with tiny freckle-size dots of blood trapped under the skin at the hair follicles. * * * He looked back at the patient. Did her gums ever bleed when she brushed her teeth, he asked. All the time, she exclaimed.  Can I see? the young doctor asked. Her gums were swollen and beefy red.

"What kind of foods do you eat? he asked. Every morning she had two scrambled eggs. For lunch she had tuna on crackers. And for dinner she had more scrambled eggs and rice. Did she ever eat any fruits or vegetables — especially oranges or lemons? Never, she told him. They gave her wicked heartburn.  She had something known as gastroparesis, she explained. Her stomach and intestines didn't move food forward normally, and so food stayed in her stomach for hours. When food moves that slowly, you have to be careful that what you eat agrees with you.

"In the mid-18th century, a naval surgeon named James Lind proved that the juice of oranges and lemons would cure the bony aches, strange bleeding and sudden death of sailors afflicted with the illness, and the British Navy later mandated the use of lemon juice on all vessels. But it wasn’t until the 20th century that researchers recognized that the cause of scurvy was the lack of a certain nutrient, which they named vitamin C. Without this organic chemical, new connective tissue, essential for the repair or replacement of damaged or dying cells, cannot be made, and that causes the bleeding, the bruising, the telltale little red dots and the terrible fatigue. Our bodies can’t make vitamin C

Note:
(a) An MD almost always append the degree to his or her name. So readers know Lisa Sanders is one. But in a rare move, NYT publishes, in the table of contents of this issue, a photo of hers plus a short description about her: "Lisa Sanders is an internist and a teacher at the Yale School of Medicine."

She is "Associate Professor of Medicine (General Medicine)." The words within parentheses means primary care.
https://medicine.yale.edu/intmed/people/lisa_sanders.profile
("Sanders' path to medicine was anything but traditional. As an undergraduate at the College of William and Mary, she majored in English and [worked as a television reporters] * * * After two years at Columbia University’s Post-Baccalaureate Premedical Program, Sanders was accepted to the Yale School of Medicine 'as part of the 10 percent of the class they reserve for weirdos,' she said")

The respective class size for Yale and Harvard medical school is 100 and 165. The MD/PhD program in each school is admitted separately, for Harvard, it is additional 13 students.

(b) Quotation 1 describes the patient's "legs. They were covered with tiny freckle-size dots of blood trapped under the skin at the hair follicles"
(i)
(A) petechia
https://en.wikipedia.org/wiki/Petechia
(Petechiae are by definition less than 3 mm; increase in size is purpura [3-10mm] and ecchymosis)
(B) petechia (n; [via] New Latin from Italian petecchia]
https://www.merriam-webster.com/dictionary/petechia
(pronunciation)

Because the noun is a Latin word, its plural form is petechiae (similar to alumna/alumnae).
(ii) The term "at the hair follicles" is misleading. Petechiae should not be limited to hair follicles, which carry no greater risk for bleeding.

(c) Move on to quotation 2.

Gastroparesis. PubMed Health (service provided by the National Center for Biotechnology Information (NCBI) ), undated.
https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0027317/
("causes slow emptying, vomiting, nausea, or bloating. * * * Most people diagnosed with gastroparesis have idiopathic [also known as 'primary'] gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. [The following discussion talks about known causes, therefore not idiopathic anymore, but 'secondary' in medical terminology) Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. Other identifiable causes of gastroparesis include intestinal surgery and nervous system diseases such as Parkinson's disease or multiple sclerosis")

In medicine, paresis is relative to paralysis. In the latter, one can not move (his leg, say), but in the former, one can PARTIALLY.

(d)
(i) About quotation 3. Scottish surgeon James Lind was not the first to make the discovery. See vitamin c
https://en.wikipedia.org/wiki/Vitamin_C
(section 5 Mechanism of action, section 5.1 Enzymatic cofactor: Vitamin c acts as a cofactor to 3 enzymes to make amino acids hydroxyproline and hydroxylysine, major components of collagen 胶原蛋白; section 9 History)
(ii)
(A) Thomas H Jukes, The Identification of Vitamin C, an Historical Summary. Journal of Nutrition, 118: 1290-1293 (1988)
https://academic.oup.com/jn/arti ... 49/jn1180111290.pdf

Read only page 1290, starting with the paragraph that talks about "Hoist and Frölic" who established guinea pig model for scurvy.
(B) hexuronic acid
https://en.wikipedia.org/wiki/Hexuronic_acid
(may refer to "ascorbic acid (vitamin C), formerly known as hexuronic acid")

(e) Looking back, even with the correct diagnosis, I -- and most likely the doctors in Mass General Hospital and Lisa Sanders -- do not know how to the symptom described in paragraph 3 of the article: "It all seemed to start the previous autumn, when she dropped a can of paint on her foot. It gave her a big bruise. No surprise, but strangely, the bruise never went away. Instead, over the next several weeks, the purple discoloration and swelling snaked up her calf into her thigh and then over to her other leg."