News & Events

COVID-19 OFFICE POLICY

As our patient community and staff member heath is our top priority, we have implemented the following protocol during the COVID-19 pandemic. This will be updated regularly.

We continue to service patients with critical care both in office and through Telehealth.  Our patients must make an appointment in advance as we are staggering appointment times. New patients are welcome but appointments are required. No drop ins are permitted at this time.

As cancer patients are at a higher risk for complications and severe symptoms associated with COVID-19, we implemented protocol to help eliminate the risk of exposure. Many of our patients are vulnerable and undergoing surgery, chemotherapy or other immune suppressive treatments.  At this time, no patient support people are permitted. We request that patients come to the office unaccompanied, by yourself, and wearing a mask. If this is not possible in serious situations, we ask caregivers to wear a mask and maintain social distancing in our reception area.

Please note that masks and hand sanitizer are available upon entry into our reception room.  

Please call the office in advance of your visit if you are experiencing any of the following symptoms:

  • Fever
  • Cough
  • Severe chest pain or difficulty breathing
  • Flu-like or other respiratory symptoms

A staff member may call you prior to your appointment to assess your health situation and your care may be directed off-site.

Additional Office Measures and Protocol

  • Plexi barrier installed at our reception area;
  • Masks and hand sanitizer available upon entrance;
  • Magazines and books and any items that can transfer germs have been removed from our patient resources and treatment rooms;
  • Ceramic mugs replaced with disposal drinking cups
  • If the patient wishes, payment arrangements can be made in advance to allow for contactless exit from appointment;
  • Continuous HEPA air filtration system in IV room;
  • Disinfection procedures of office fixtures as well as regular cleaning of high-touch surfaces including:
    • Patient chairs
    • Door handles
    • Counters
    • Washroom fixtures
  • Outside packages and mail to be isolated upon arrival to the office

Please note: No industrial spray or aerosol disinfectants are used. We are very conscious of keeping our office air free of disinfectant spray and ensuring our patients safety from potentially harmful inhalable substances.

 

Additional COVID-19 Resources:

Guidelines as also provided by the BC Cancer Agency and COVID-19 found in the below link:

http://www.bccancer.bc.ca/about/news-stories/news/2020/covid-19-and-cancer-treatments

 

Please note: the province has created a phone service to provide non-medical information on COVID-19 including the latest information on travel restrictions. Available 7:30 am – 8:00 pm PST at 1-888-COVID19 (1-888-268-4319) or text at 604-630-0300.

High Dose Vitamin C Enhances Cancer Immune Drugs

April 20 2020

A recent study from Italy, in mice, for the first time is showing the potential of high doses of vitamin C stimulate the immune system to enhance the effectiveness of popular immune therapy cancer drugs known as checkpoint inhibitors (i.e. Yervoy, Optivo, Keytruda, etc.).  Vitamin C was studied looking at the adaptive part of the immune system that involves a part of the white blood cells known as lymphocytes or T cells.  The experiments suggest that vitamin C could be critical in priming the immune system as well as during lymphocyte-linked cancer killing.  In part, the vitamin C increased the number of tumor-infiltrating lymphocytes (T cells) and enhanced activation of CD4 and CD8 T cells that are important signs in immune cancer killing.  This may help to explain why, on its own, vitamin C could slow the growth of tumors in those having an intact immune system. High dose vitamin C enhanced the effectiveness of combined checkpoint inhibitors (i.e. anti–CTLA-4 and anti–PD-1 blockade) in breast, pancreatic, and colorectal MMR-proficient mice models (i.e. a triplet therapy). Not only did this combination delay tumor growth in most cases, but also in a few mice, complete regressions were observed.  Furthermore, in colorectal cancers where checkpoint inhibitors appear to have greater immune system roles (i.e. MMR-deficient), the combination with vitamin C opened the doorway of response producing significant and lasting tumor shrinkage. These same cancers were also more anti-cancer sensitive to vitamin C when used on its own as well. No signs of immune-related adverse events or other toxicities were seen in animals treated with vitamin C and check point inhibitors, suggesting that combination approaches may be tolerated by people with cancer.  The doses used of vitamin C would only be possible by using intravenous doses in humans.

Anecdotally, experimentally, we have been incorporating the use of vitamin C along with checkpoint inhibitors for several years now.  For example, when the use of Yervoy (Ipilimumab) was first used in clinical trials for advanced melanoma and before it became an indication for this cancer (i.e. forever changing the landscape for this disease and others), some of our patients also used intravenous vitamin C along side.  Later combination approaches such as Optivo (Nivolumab) began to follow showing enhanced outcomes and, once again, high doses of vitamin C were also experimentally utilized by some of our patients along side.  Such checkpoint inhibitors and a growing list of others (i.e. Keytruda, etc.) have now become common place in oncology used and approved for a wide variety of cancers. We have applied vitamin C to many of these checkpoint inhibitors. I feel privileged to have been in practice for 20 years and to see the gradual growth and acceptance of immune treatment now common in oncology.  There was much skepticism and criticism about this area that perhaps younger oncologists may not be aware of who now walk onto a much smoother and laid out path in an oncology world more open to this area.  While yet to be published, we have noticed similar trends to this Italian animal study that a positive relationship appears to exist between vitamin C and checkpoint inhibitors and without any obvious added immune system toxicities.  Vitamin C appears to support the immune system plus other parts of the body as well.  After all it is an essential nutrient that the body does not make and needs to use to survive. Mice can make vitamin C while humans do not. We suspect, the value of vitamin C becomes even more important when a person has a poor performance status or simply when a person is becoming and looking more tired as the disease progresses and begins to take a toll on the body.  We know, especially in advanced cancers, that vitamin C levels are lower than the general population and may even be deficient. Is the immune system response weaker in such cases as a result? We suspect if you are tired so can your immune system in its ability to respond.

This study deserves attention as the Italian researchers have performed a very good and detailed first step in this area of vitamin C immuno-oncology.  I am certain we will be seeing more of this kind research and eventually applied to humans as time moves forward. We also suspect this will be an area where vitamin C used in high doses, by intravenous, will shine when combined with such immune checkpoint inhibitors.

Reference:

https://stm.sciencemag.org/content/12/532/eaay8707

New York Listens as Vitamin C Intravenous Becomes a Treatment Tool in COVID-19.

March 24 2020

It has been released today in the New York Post that vitamin C given by intravenous injection becomes a treatment tool for COVID-19.  The preliminary data from China on how patients did better sparked an interest to US physicians on how to better help out their patients during this pandemic.  In addition to some of the known drug treatments such as hydroxychloroquine and azithromycin being explored plus other current standard supportive approaches used in the management of COVID-19, vitamin C has now been officially added to the experimental toolbox (i.e. similar in approach to the Shanghai Protocol in China). Congratulations to New York pulmonologist and critical-care specialist Dr. Andrew Weber and team for putting politics aside, and to do whatever it takes to help patients during this critical time in a  hospital setting.  We will now be able to try and assess how treatment outcomes compares to China in the management of COVID-19 with the addition of this popular and yet controversial vitamin.  Some would have used a higher dosing model than what is being used in New York.  Time will tell.

https://nypost.com/2020/03/24/new-york-hospitals-treating-coronavirus-patients-with-vitamin-c/

As everyone talks about Chloroquine, including President Trump, to potentially help in the treatment of novel coronavirus COVID-19, again, where is vitamin C?

March 22 2020

There has been preliminary research from China suggesting that the anti-malaria and anti-inflammatory drug hydroxy-chloroquine (i.e. Plaquenil) may have value in the treatment of COVID-19.  People are now stock pilling this drug. However what has been missed in the mainstream media, which has also been utilized in the management of COVID-19, is vitamin C given by intravenous injection.  In fact it has been suggested from China that vitamin C should be used early on in treatment and that it appears to decrease hospital stay and support recovery.  There is a medical protocol from China known as the “Shanghai Protocol” that details both the conventional (i.e. using drugs, ventilators, etc.)  plus vitamin C intravenous in addition to Traditional Chinese Medicine in the management of COVID-19.  The document is written in Chinese and is by the Shanghai Medical Association entitled “Expert consensus on comprehensive treatment of coronavirus disease in Shanghai 2019”. All combined this approach may also help to support the weakened body and immune system recover which may be an important missing piece.  Does this help improve survival? Again this may also help decrease the load in the overloaded hospitals such as Italy and other potential regions of the world.  Drugs have limits and especially when the body is tired and overloaded – an observation repeatedly seen in our cancer care practice throughout the years. I have not heard of other European, Canadian or US hospitals utilize this potential tool as of yet but rather only the drugs have been emphasized (besides ventilators, ECMO, etc.).  I have observed that China is not polarized in this area but rather integrates whatever may help.  In my experiences using vitamin C intravenous in cancer, the earlier integrated in care the better and I would assume the same would apply in COVID-19 treatment as in what has been suggested in China.  And once again, vitamin C is a low cost and relatively low side-effect tool with a long history of use.

Intravenous Vitamin C and the Treatment of Acute Respiratory Distress Syndrome? – A Case Report

March 11 2020

I recently learned about a published case report from the United States in 2017 on the use of intravenous vitamin C involved in the treatment of virus-induced acute respiratory distress syndrome (ARDS) similar to what the Coronavirus can do in select groups (see reference below). When reading the details of this case I was reminded about my home roots and the poor unfortunate people of Italy with the current COVID-19 outbreak and the lives lost. Our hearts go out to them in support.

In particular, this case involved a 20-year-old, previously healthy, female who contracted respiratory enterovirus/rhinovirus infection in central Italy while on an 8-day spring break from college. During a return flight to the United States, she developed increasing shortness of breath and low blood oxygen that rapidly developed into acute lung injury that led to acute respiratory distress syndrome. When hospitalized and support with mechanical ventilation failed, extracorporeal membrane oxygenation (ECMO) was initiated. ECMO can be used in late-stage respiratory failure to try and oxygenate the blood using a machine outside the body. Twelve hours after beginning ECMO, high dose intravenous vitamin C began and administered every 6 hours, 24 hours per day. The patient’s recovery was rapid. ECMO and mechanical ventilation were discontinued by day-7 and the patient rapidly recovered with no long-term ARDS after-effects. She was discharged home 12 days following hospitalization, requiring no oxygen therapy. Follow-up exam 1 month after the patient’s initial hospitalization revealed her to have completely recovered. Again no complications.

While this is a single case report and there can be levels of criticism, it also involved a younger patient with no known health conditions vs. a senior that typically has other diseases, a different virus than the Coronavirus, it nonetheless was used to treat a similar presentation of a virus-related acute respiratory infection that could have been deadly. China has been public about integrating intravenous vitamin C in the treatment of COVID-19 acute respiratory infection that I have discussed in a previous article. It would be unfortunate to later learn that something as simple as vitamin C given by intravenous injection may have helped to offset some of the deaths or complications reported in the media.   I hope Italy will be as pro-active as some of the centres in China in taking bold measures in helping out their citizens and explore vitamin C. In my opinion, intravenous vitamin C should be given a chance in the evolving experiment of treating COVID-19 and the acute respiratory problems that may occur.

References:

https://www.wjgnet.com/2220-3141/full/v6/i1/85.htm

https://www.lemmo.com/with-the-growing-fears-of-coronavirus-covid-19-where-is-vitamin-c/

With the growing fears of coronavirus COVID-19 where is vitamin C?

March 1 2020

There is now constant social and news media outlet reports regarding the spread of coronavirus COVID-19, its pandemic or rising global concerns, the search for a vaccine, the fears on the complications it can have (i.e. which can include death), where even here in Vancouver, Canada upcoming spring-break trips involving families are being cancelled, people are stocking up on home supplies in droves at Costco, all the while there is an interesting simple experiment in the works in China which involves vitamin C and COVID-19.

At ground zero, in the Wuhan province of China, a hospital is exploring the use of simple vitamin C given by intravenous injection to help treat those infected with the COVID-19 virus and the complications that it causes (i.e. severe acute respiratory infection). A legitimate clinical trial has been created and is listed at the US National Institute of Health (NIH) database. To my knowledge this is a first in the modern global era on the use of vitamin C as a potential immune, body supportive, anti-viral agent integrated into conventional hospital protocols targeting a population group with a potentially contagious virus on the verge of becoming a global pandemic. Personally, I am not too surprised about the progressive stance of China as I have been seeing growing noteworthy trends from the scientific literature on the use of intravenous vitamin C applied in the surgical, oncology, and hematology hospital settings. A PhD by the name of Dr. Andrew Saul here in North America has been talking about this COVID-19 and vitamin C issue for quite sometime on social media and reports to be in regular contact with researchers in China on the matter.

It has been repeatedly reported in the historic literature that vitamin C may play an active role in the fight of infection (i.e. a non-specific anti-viral, anti-microbial agent). For example a 2017 study from Finland by Dr. Harri Hemila MD PhD from the Department of Public Health discusses this potential use of vitamin C and is free to read online which is also listed on the NIH database called PubMed and where dosing information can be found (references below). Furthermore Dr. Hemila and colleague also published in the highly respected Cochrane in 2013 on how vitamin C supplementation could have a role and how it could prevent and treat pneumonia in those high-risk groups and in those who have lower blood levels of vitamin C. Interestingly how many people do you know where their vitamin C levels have been checked when not feeling well? Do you know if you are low or borderline? Are such persons more vulnerable? I don’t know personally from myself either as it is not a routine blood test. Regardless while there is no known or approved anti-viral agent or agents or protocol known to help treat COVID-19 many drugs are rightfully being used regardless in hospital for such positive and potentially life threatening cases. So why isn’t the rest of the world (besides China) also exploring vitamin C into the mix of treatments for COVID-19? I have not heard one word.

What would be the harm with even a more general oral supplementation in those who are worried as a preventative or those who feel weak or are vulnerable for even short-term use (i.e. a few months)? Overall vitamin C can be quite a benign vitamin with perhaps the chance of looser stools / diarrhea-like symptoms for those who take too much orally or have sensitive bowels. The value of the intravenous route is it can bypass the gut and is thus 100% absorbed (i.e. no stomach upset).

People are wearing masks all over the world in fear, in the hopes of protection, and we are uncertain if this approach helps. Can a relatively gentle oral vitamin C program assist here? We know some people are carrying the virus without any obvious signs or symptoms. Is this because their immune system is keeping it controlled? Do they have good vitamin C stores in the body? We need to learn from these people. In one recent 2019 paper from the U.K. by Dr. Myint and team, higher blood vitamin C levels which was used as a marker for higher fruit and vegetable consumption was linked with reduced risk of respiratory illnesses including non-smoking-related cancer incidence and death. A good diet most likely does not hurt along with being physically active. Moreover, fundamental good hygiene principles such as hand washing and protecting / respecting others if you personally do not feel well, are sick, or are feverish are of importance.

Vitamin C has also been shown to help with stress too as its involved with the hypothalamic pituitary (HPA) axis and neurotransmitter function. We know people are scared. From personal clinical experience, in helping patients with challenging medical conditions, vitamin C can have a role. We know that older more senior populations perhaps those with pre-existing health conditions may be a target population for this virus and the potentially serious complications it can cause. Perhaps they should be pro-actively supplemented with oral vitamin C while we learn more.

What people do not understand, including most healthcare providers, is that a person does not need to have “scurvy”, or more severe signs of vitamin C deficiency, to be low or marginally deficient for yet to demonstrate beginning signs or symptoms of inadequate vitamin C levels in the body. People seem to forget that one of the first symptoms of vitamin C deficiency is fatigue (i.e. a sign of the body not running optimally). I know there are many roads to fatigue but lower vitamin C can also be one and especially in those with pre-existing medical conditions. If you are tired your immune system can be too.

I hope to hear more about vitamin C and its potential roles with COVID-19 in the news media and considerations of an experimental pro-active prevention model in more vulnerable population group using supplemental vitamin C. British Columbia has been proactive in its response and testing for COVID-19 and should be congratulated. It would good to also hear about how vitamin C, simple, readily available, cheap, and with minimal risks overall may also play in those affected with COVID-19 but also for its potential applications in prevention while an effective safe vaccine waits. A lesson can be learned from the Chinese model in thinking outside the standard box. This has become a much more concerning global public health matter and no stone should be left unturned.

Dr. Walter Lemmo, N.D.

References:

https://clinicaltrials.gov/ct2/show/NCT04264533

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409678/

https://www.cochrane.org/CD005532/ARI_vitamin-c-for-preventing-and-treating-pneumonia

https://www.ncbi.nlm.nih.gov/pubmed/30705384

https://www.ncbi.nlm.nih.gov/pubmed/11862365

https://www.ncbi.nlm.nih.gov/pubmed/25010554

An Integrative Approach to Ovarian Cancer Suggests Improved Survival

A recent review from a gynaecology oncology clinic in Malaysia reports that patients with advanced and recurrent ovarian cancer who were properly guided and incorporate an integrative medicine approach early which included intravenous vitamin C as a tool lived longer. Such approaches were used either alone and monitored and also together with surgery and / or chemotherapy as needed. Integrative medicine was a foundational element throughout care (i.e. diet, life style, natural medicine, supplements, meditation, etc.). The patients who only used chemotherapy (and without an integrative approach) did not live as long. While this work is preliminary, retrospective, and it lacked a comparative group  it mirrors what we have  seen in clinical practice with patients with ovarian cancer as well here in Vancouver.   It was also interesting to note that the case series obtained publication approval from Director General of Health, Ministry of Health, Malaysia.  Other government groups here in Canada should follow.

Ovarian Cancer Integrative Medicine Approach and Survival Nov_2019

Respected Canadian Cancer Journal Publishes Naturopathic Cancer Guidelines

Respected Canadian cancer journal Current Oncology acknowledges and publishes article by the Oncology Association of Naturopathic Physicians on recommended guidelines for the role of naturopathic medicine applied to people with cancer.  Well done!! To learn more about the article, it can be found below.

Oncology Association of Naturopathic Physicians- Principles of Care Guidelines

NEW – Intravenous Vitamin C – A Collaborative Article Between Oncologists and Naturopathic Physicians Working Together

New research on the practical use of Intravenous Vitamin C (IVC) in cancer from medical oncologists and naturopathic physicians working together which also includes discussions on how to use along with chemotherapy.  The lower dosing guidelines as suggested in this article have been long supported in our clinical experiences as well.

IVC Supportive Care Review and Rational Approach Klimant et al Current Onc 2018