May 25, 2017
‘You literally could see, day by day, her X-rays getting better and better’
Vitamin C, used to treat Kelsey Martin in 2015, could be a successful treatment for sepsis, according to a VCU clinical trial.
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There are big gaps in Kelsey Martin’s memory when it comes to her life-threatening diagnosis two years ago. She remembers her spring break trip to Italy. She remembers not feeling well after returning to the United States. She remembers being intubated after having trouble breathing.
After that, she only recollects waking up in a hospital room, restrained and confused about where she was.
“I thought I was still in Italy,” she said.
Actually, Martin was in Richmond, at Virginia Commonwealth University Medical Center, about 100 miles from her home in Clifton, Virginia. She had suffered a bout of sepsis that nearly took her life, until VCU Health doctors put her on an ECMO machine and gave her a lifesaving treatment of intravenous Vitamin C. The treatment was designed as part of an ongoing clinical trial that examines using high doses of Vitamin C, a water-soluble vitamin commonly associated with oranges, to treat septic lung injury resulting from infection. Within seven days of receiving treatment, Martin was feeling better, her family said, and on a road to recovery that didn’t at first seem possible.
“We live in [an area] where there are huge teaching facilities and either no one wanted to take Kelsey or they didn’t have an ECMO machine,” said Mary Thomson-Martin, Kelsey’s mother. “This is why VCU will always have a special place in my heart. They literally saved her life.”
When Kelsey Martin fell ill, VCU Health Department of Surgery chair Vigneshwar Kasirajan, M.D., at the prompting of doctors at Inova Fair Oaks Hospital, traveled in VCU LifeEvac, the university’s helicopter transport, to treat her. Kasirajan brought with him a portable ECMO machine. The instrument drains blood from a patient’s vein, adds oxygen and removes carbon dioxide. It then warms the blood, and returns it to a large vein so the heart can pump the blood, with improved oxygen, through the body.
Kelsey Martin likely would not have survived the night without the ECMO machine and the intravenous Vitamin C infusions initiated at VCU’s Cardiothoracic Intensive Care Unit.
“The randomness of the whole thing is what amazes me,” said Eric Martin, Kelsey’s father. “It’s amazing how [her condition] went downhill so fast.”
What is sepsis?
Sepsis is a caused by the body's overwhelming and life-threatening reaction to infection, according to the Centers for Disease Control. It can lead to rapid tissue damage, organ failure, and death, and is often contracted while a patient is in the hospital because of germ prevalence. A combination of symptoms can indicate sepsis, including high heart rate, fast breathing or shortness of breath and delirium. Approximately 350,000 people die each year from sepsis.
In 2013, Alpha A. (Berry) Fowler, a professor in the Pulmonary/Critical Care Division in Department of Internal Medicine at the VCU School of Medicine, began work as principal investigator to determine which high doses of Vitamin C were useful in treating septic lung injury. Fowler’s research was supported by a $3.2 million National Institute of Health grant. Preclinical testing in the laboratories of Ramesh Natarajan, Ph.D., an associate professor in the Department of Internal Medicine, began years earlier to examine Vitamin C’s effectiveness in mice with lung injury from sepsis.
The NIH grant funded a multicenter trial that includes the Cleveland Clinic, the Medical College of Wisconsin and the University of Kentucky. As the trial nears its end this year, Fowler said research results are gearing up to wield worldwide influence. Currently 130 people are enrolled in the trial across the enrollment sites. In 2014, Fowler and his VCU colleagues published early study results that showed high doses of Vitamin C prevented the inflammatory responses from sepsis. In the placebo group that didn’t receive Vitamin C, mortality was 62 percent. Conversely, among the group given Vitamin C for four days, mortality was 38 percent.
“If Vitamin C, after a randomized, placebo-controlled, double-blinded trial, turns out to be successful, then this therapy, which will save lives across the world, will have been invented at VCU,” Fowler said.
Bench to Bedside
In most instances, and because sepsis patients are so ill, their family members are consulted about their medical care and the possibility of being part of a clinical trial.
That is a delicate dance, said Chris DeWilde, associate director of the clinical research program at the VCU Health Johnson Center for Critical Care and Pulmonary Research. DeWilde works directly with sepsis patients and their families.
“It is a process of slowly going through what being in a clinical trial would look like while also being respectful and holding space for the experience that they’re having with their sick family member,” she said.
Eric Martin raised his eyebrows when he was initially told of the new therapy physicians wanted to use to treat his daughter.
“I was not sure at the time that it would be that vital or important,” he said. “But, I thought, hey throw an aspirin in there, too, if it’s going to work.”
Once treated with the regimen, Kelsey Martin’s condition improved exponentially.
“You literally could see, day by day, her X-rays getting better and better,” Mary Thomson-Martin said.
High doses of Vitamin C, Natarajan said, reduces inflammation by removing proteins that drive inflammatory factors in the body when there is sepsis. It also prevents multiple organ injury. From the view of a chest X-ray, the less ‘cloudy’ the image, the better the patient is doing. Having bench research put into practice at the bedside is a combination of efforts that is priceless, he said.
“If we come up with a way to treat a patient, and we have someone like a Dr. Fowler who can trust you and translate that bench research to a patient, and you actually see it saves patients’ lives, there is nothing better in research,” said Natarajan.
‘I wanted to meet the people who saved my life’
Throughout the Martin family’s experience at VCU Medical Center, they said they were treated with respect and kept informed of Kelsey Martin’s status.
“They were always so willing to share information and to be so honest with us,” Mary Thomson-Martin said.
One year after her illness, Kelsey Martin graduated from James Madison University with an international affairs degree. She now works as a substitute teacher, and will soon begin as an instructional assistant for behavior forFairfax County Public Schools. She’s also earning her master’s degree in special education at George Mason University. Like it was yesterday, she tears up when speaking about her medical journey and the VCU team who nursed her back to good health.
Last year, the Martin family returned to Richmond to visit the nurses and physicians who treated her.
“I didn’t really want to go back, but I wanted to meet the people who saved my life,” Kelsey Martin said. If not for them, “I wouldn’t get to work with the people I work with. I wouldn’t get to see [my sister] move into her first house.”
She was the sickest person in the hospital at 20 years old, and then six days later she was well on her way her to recovery.
It was determined that Kelsey Martin developed sepsis from a severe viral infection she acquired in Italy. Now 22, she has no lasting medical effects from her sickness. That alone puts life into perspective for the Martin family.
“We are not church goers, but I do have a faith and my faith in a higher power was just completely restored and opened up,” Mary Thomson-Martin said. “It was a miracle, it truly was. I say this all the time to everyone who knows the story, that we will forever sing the praises of VCU. To be told she was the sickest person in the hospital at 20 years old, and then six days later she was well on her way her to recovery.”
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