Vitamin C

Vitamin C is an essential dietary nutrient required for the biosynthesis of collagen and a co-factor in the biosynthesis of catecholamine, L-carnitine, cholesterol, amino acids and some peptide hormones. A lack of vitamin C causes scurvy, a pathological condition that leads to blood vessel fragility and connective tissue damage due to a failure in producing collagen, which leads to death as a result of collapse. Vitamin C is also important in cancer and cardiovascular prevention and has the potential to counteract inflammation and subsequent oxidative damage that play a major role in the initiation and progression of several other chronic and acute diseases.

Vitamin C, or ascorbic acid, is a water-soluble vitamin. It dissolves in water and is delivered to the body’s tissues but is not well stored, so it has to be taken daily through food or supplements. Even before its discovery in 1932, nutrition experts recognised that something in citrus fruits could prevent scurvy, a disease that killed nearly two million sailors between 1500 and 1800.

Vitamin C plays an important role in controlling infections and healing wounds and is a powerful antioxidant that can neutralise harmful free radicals. It is needed to make collagen, a fibrous protein in connective tissue that is weaved throughout various systems in the body: nervous, immune, bone, cartilage and blood. The vitamin helps make several hormones and chemical messengers used in the brain and nerves.

Vitamin C in large doses can cure or treat heart disease, cancer, stroke, chronic lower respiratory infections, influenza and pneumonia. High dose vitamin C reduces or eliminates the need for antibiotics, blood thinners, antivirals, pain killers and blood pressure medications.

Ascorbic acid destroys viruses and bacteria, kills cancer cells, prevents heart disease, reduces blood pressure, decreases the risks of stroke, reduces pain, inhibits HIV replication, reduces blood clots and much more!

History of Vitamin C Deficiency and Malnutrition

Those of us lucky enough to eat nutritious meals daily do not consider what would happen if fresh fruits or vegetables or vitamin supplemented produce was not easily available. Centuries ago, sailors experienced a lack first-hand, experiencing swollen and bleeding gums, loose teeth, haemorrhaging under the skin and slow healing of wounds. What we now know as vitamin C was in short supply on most ships, and the sailors developed a condition known as scurvy.

At the end of the 15th century, scurvy was cited as the major cause of disability and mortality among sailors on long sea voyages. Danish mariners were long acquainted with the condition and included supplies of lemons and oranges on their ships; it was not until 1753 that scurvy was recognised in the British medical community and cited as being directly related to dietary deficiency.

In 1769, William Stark, a British physician, experimented with diet and nutrition, using himself as the subject. He consumed only bread and water for 31 days and started to add other foods to his diet one-by-one, including olive oil, figs, goose meat and milk. After two months, Stark recorded that his gums were swollen and red and bled easily when touched. He died seven months later, possibly from scurvy and a cumulative effect of malnutrition. Stark’s diet was devoid of vegetables and citrus fruits and was heavy on meat and starch.

Twelve years prior to Stark’s ill-fated experiments, Scottish physician James Lind, having observed that citrus fruits and lemon juice had preventative and curative powers during his years as a naval surgeon, wrote a treatise recommencing that British sailors mandatorily consumed them. By 1795, Lind’s advocacy resulted in the issuance of lime juice to all naval vessels and, with it, the eventual and gradual elimination of scurvy within the British fleet.

It would take many more years for scientists to pinpoint the scurvy-prevention substance that was responsible for maintaining the body’s connective tissues. Albert Szent-Gyorgyi, a Hungarian-born researcher, isolated and identified vitamin C and the discovery of its metabolic mechanism that enables its use within cells. For this, he was recognised with a Nobel Prize in Physiology or Medicine.

Vitamin C and the body

Vitamin C enables the body to efficiently use carbohydrates, fats and protein. Vitamin C acts as an antioxidant, a nutrient that chemically binds and neutralises the tissue-damaging effects of free-radicals. It is essential for the growth and health of bones, teeth, gums, ligaments and blood vessels. Vitamin C is also vital in the key role of the formation of collagen and the proper functioning of all internal organs.

Vitamin C is found in many foods, including citrus fruits such as oranges, grapefruits and lemons. It is also found in green vegetables such as spinach, broccoli and cabbage, as well as tomatoes and potatoes. The processing of food degrades vitamin C, as can exposure to air, cooking or processing.

Vitamin C deficiency these days are isolated towards the elderly or those with certain illnesses such as AIDS, cancer or tuberculosis, as well as those exposed to long periods of cold temperatures.

Benefits of vitamin C

• Heals wounds, burns and bleeding gums
• Increase the effectiveness of other medications
• Accelerates healing after surgery
• It helps to decrease blood cholesterol
• Aids in preventing many types of viral and bacterial infections and boosts the immune system.
• Protects against many forms of cancer
• Acts as a natural laxative
• Lowers the risk of blood clots in veins
• Treats and prevents colds and flu
• Extends life by enabling protein cells to hold together
• Increases the absorption of inorganic iron
• Reduces the effects of many allergy-producing substances.
• It helps to lower high blood pressure
• Prevents scurvy
• Reduces the risk of stroke
• Reduces the onset of ageing skin

Sources of vitamin C

• Citrus fruits such as oranges, lemons and grapefruit
• Berries
• Green and leafy vegetables
• Tomatoes
• Cantaloupe
• Cauliflower
• Potatoes
• Peppers

You can also get vitamin C from dietary supplements. Vitamin C supplements are available in many forms:

• Oral tablets
• Chewable tablets
• Extended-release tablets
• Extended-release capsules
• Prescription of intramuscular

Oral supplements may be preferred by the client, but the effects can be reduced, and oral supplements can cause long term issues such as kidney stones or digestive stress.

Oral vitamin supplements have to through the digestion process before they are absorbed into the bloodstream. Injections, on the other hand, deliver larger doses direct to the bloodstream. The body will absorb the full amount of injected vitamin C, unlike supplements, which, after digestion, will only deliver a portion of the dose they originally contained.

Oral supplements are available in 500mg concentrations, whereas vitamin C injections are available from 1g to 25g if required.

Vitamin C supplements are less expensive than injections, but in the case of severe symptoms, cold, flu or infection, the client would need several bottles of vitamin C to get the same dose as one injection.

Recommended Daily Amounts

Recommended daily amounts – the recommended dietary allowance for adults is 90mg daily for men and 75mg for women. Smoking can deplete vitamin C levels in the body, so an additional 35mg beyond the RDA is recommended.

Upper intake limit – the tolerable upper intake level is the maximum daily intake unlikely to cause harmful effects on the body. The UL for vitamin C is 2000mg daily. Beyond this amount, the client may suffer from side effects such as diarrhoea. Higher doses may be given only under medical supervision.

Vitamin C Toxicity

The tolerable upper intake level (UL) for vitamin C from dietary sources and supplements combined is:

• Ages 1-3: 400 mg/day
• Ages 4-8: 650 mg/day
• Ages 9-13: 1,200 mg/day
• Ages 14-18: 1,800 mg/day
• Ages 19+: 2,000 mg/day

Vitamin C absorption and mega-dosing

The intestines have a limited ability to absorb vitamin C. Studies show that absorption of vitamin C decreases to less than 50% when taking amounts higher than 1000mg. In healthy adults, a mega-dose of vitamin C is non-toxic because once the body’s tissues are saturated with vitamin C, absorption decreases, and any excess is removed from the body through urination.

Doses of 3000mg or higher will increase the risk of diarrhoea, kidney stones, increased levels of uric acid and increased iron absorption.

Client Consultation

A client consultation is a one to one talk with your client. During this time, you will find out very important and confidential information that will allow you to advise and provide the best treatment for the client.

It is important to always introduce yourself to the client as this removes any barriers and relaxes them. Consultations should always be undertaken in a private room or area where you cannot be overheard by others.

A client should first fill out a client consultation which helps identify any contra-indications that may mean you have to alter the treatment or be unable to treat them at all. If their form shows no reason why they cannot proceed with the treatment, then you can move onto verbal questioning.

Verbal questions would be to establish why the client has visited the salon and what their expectations and outcome of the treatment may be. Asking what they want ensures you can provide customer satisfaction as the client should be pleased with the outcome of their treatment. It is good practice to speak to the client in front of a mirror and explain the treatment to them and see if that meets their requirements.

Once you have established what the client is after, then a physical examination should be undertaken. This allows you to further check for any undeclared contra-indications and get a better overview of any issues that you may face during the procedure.

Allow around 15 minutes for the client's first salon visit. Ideally, you should sit face to face or next to the client to create an open atmosphere. Avoid barriers such as a couch or table between you.

Use open questions to tactfully encourage the client to give you information that you may need rather than using interrogating questioning techniques. Use the consultation form to work from and record anything you may discuss.

Record Keeping

Records must be maintained and updated for a number of reasons.

• They provide contact details in case you need to alter or cancel an upcoming appointment.
• So that you can track client’s progression.
• To record the products used and timings so you can use these at further visits and adjust the treatment plan if required.
• Tracks any aftercare you provide the client.
• Records patch test history.
• As a backup in case, the client has an adverse reaction to treatment.
• For legal reasons if the client brings a claim against you.

Client records can be stored electronically or filed away manually and should be updated at every visit. If consultation forms are not updated and do not contain a history of services and dates, then you may find your insurance invalid.

Forms should be kept for the timeframe suggested by your insurance company. This may be for up to six years. If a client is under 21 at the time of service, then it is recommended to keep the forms for six years past their 21st birthday.

Client confidentiality must be protected at all times. Forms need to be locked away in a secure cabinet, and electronic records should be held on a password-protected computer. You may also need to register with the ICO as a data controller.

• All information must be accurate and necessary for the service or treatment being performed.
• Individual client records must be available for the clients to view if requested.
• Data should not be passed on or sold without the client’s prior written permission.

The following details should be recorded on the client consultation form:

• Personal details – name, address, contact details
• Results of any patch tests
• Contra-indications
• Contra-actions
• Reasons for the treatment
• Any reactions to treatments/previous treatments
• Home care advice/suggested retail items.
• Any sales
• Treatment timings/products used etc.
• Next appointment or recommendations

Any contra-indications and possible contra-actions should be identified and discussed prior to the treatment. In the case of a medical referral, the therapist should keep a copy of the GP's letter with the client's record card.

Consultation forms must be signed and dated to prove that you have covered everything and given the correct advice and treatment plan.

Contra-indications

A contraindication is the presence of a condition which may make the client unsuitable for the treatment. The treatment may not be able to take place, or the treatment will need to be adapted.

When treating a client, if they show any signs of contra-indications, you should tactfully refer them to their GP for treatment or advice. You should never make a diagnosis even if you are certain of the condition as you may be wrong.

If you are unsure about any contra-indications, then do not treat the client and refer them to their GP.

Be careful if you deal with a contra-indication, and they can often be contagious. Make sure you clean the work area and any implements between clients to prevent cross-infection.

Contra-indications

• Chemotherapy patients ( antioxidants such as Vit C can reduce the drug effect)
• Pregnancy and breastfeeding
• Known allergies or sensitivity to biotin
• Kidney/liver problems
• Unrealistic expectations
• Sickle cell anaemia
• Hormone tablets (Vit C can increase Oestrogen further)
• Protease inhibitors
• Warfarin (high Vit C levels may reduce effect)
• Statins and niacin

Contra-actions post-treatment

• Infection at the injection site
• Fainting
• Stinging
• Burning
• Bruising
• Erythema
• Oedema

Dosage

For treating vitamin C deficiency, the typical dose is 200mg once a day for up to a week.

Wound healing the injection dose is 1g once daily for 5-21 days.

Equipment Needed

• 2.5ml Syringe
• 23g, 30mm blue needle
• 21g, green drawing needle
• Vitamin C
• Antiseptic skin wipes
• Gauze or cotton wool
• Gloves
• Kidney dish
• Glass ampoule opener

Intramuscular Injections

Intramuscular (IM) injections deposit medications into the muscle fascia, which has a rich blood supply, allowing medications to be absorbed faster through muscle fibres than they are through the subcutaneous route. The IM site is used for medications that require a quick absorption rate but also a reasonably prolonged action. Due to their rich blood supply, IM injection sites can absorb larger volumes of solution. In addition, muscle tissue is less sensitive than subcutaneous tissue to irritating solutions and concentrated and viscous medications.

Intramuscular injections must be done carefully to avoid complications. Complications with IM include muscle atrophy, injury to the bone, cellulitis, sterile abscesses, pain, and nerve. With IMs, there is an increased risk of injecting the medication directly into the patient’s bloodstream. In addition, any factors that impair blood flow to the local tissue will affect the rate and extent of drug absorption.

Sites for intramuscular injections include the ventrogluteal, vastus lateralis, and deltoid site. There is sufficient evidence that the ventrogluteal IM site is the preferred site whenever possible. The ventrogluteal site is free from blood vessels and nerves and has the greatest thickness of muscle when compared to other sites. A longer needle with a larger gauge is required to penetrate deep muscle tissue. The needle is inserted at a 90-degree angle perpendicular to the client’s body or at as close to a 90-degree angle as possible. Use a quick, darting motion when inserting the needle.

Aspiration refers to the action of pulling back on the plunger for 5 seconds prior to injecting medication. The current practice is to aspirate IM injections to checking for blood return in the syringe. Lack of blood in the syringe confirms that the needle is in the muscle and not in a blood vessel. If blood is aspirated, remove the needle, discard it appropriately, and re-prepare and administer the medications.

The dorsogluteal site

The dorsogluteal (buttock) site is not routinely used due to its location near major blood vessels and nerves, as well as having an inconsistent depth of adipose tissue. Many injections in this site do not penetrate deep enough under the skin to be correctly administered in the muscle.

Since the dorsogluteal site is in close proximity to the sciatic nerve, significant injury, pain, and temporary or permanent paralysis can occur if medication damages the sciatic nerve. Damage can occur if the injection site is not mapped correctly.

IM injection into the Gluteus medius site (buttock)

• Find the trochanter. It is the knobbly top portion of the long bone in the upper leg (femur). It is the size of a golf ball.
• Find the posterior iliac crest. Many people have ‘dimples’ over this bone.
• Draw an imaginary line between the two bones
• After locating the centre of the imaginary line, find a point one inch toward the head. This is where (X) to insert the needle.
• Stretch the skin-tight
• Hold the syringe like a pencil or dart. Insert the needle at a right angle to the skin
• Up to 3ml of fluid can be given in this site.

The ventrogluteal site

Giving an IM injection into the ventrogluteal site

The Ventrogluteal site provides the greatest thickness of gluteal muscle (consisting of both the gluteus medius and gluteus minimus), is free of penetrating nerves and blood vessels, and has a narrower layer of fat of consistent thinness than is present in the dorsogluteal.

Giving an IM injection into the ventrogluteal site

• Find the trochanter. It is the knobbly top portion of the long bone in the upper leg (femur). It is about the size of a golf ball.
• Find the anterior iliac crest
• Place the palm of your hand over the trochanter. Point the first or index finger toward the anterior iliac crest. Spread the second or middle finger toward the back, making a ‘V’. The thumb should always be pointed toward the front of the leg. Always use the index finger and middle finger to make the ‘V.’
• Give the injection between the knuckles on your index and middle fingers.
• Stretch the skin-tight
• Hold the syringe like a pencil or dart. Insert the needle at a right angle to the skin (90°)
• Up to 3ml of fluid may be given in this site.

The deltoid site

The ease of access, especially in an outpatient setting, possibly adds to the frequency with which the deltoid site is used for IM injections. This site is used for immunisations/non-irritating medications; hence vaccines that are usually small in volume tend to be administered into the deltoid site. This is a relatively small area and muscle mass, especially in atrophied clients compounded by the close proximity of the radial nerve, brachial artery and bony processes to this site, means that more substantial injuries can occur.

• Find the knobbly top of the arm (acromion process)
• The top border of an inverted triangle is two finger widths down from the acromion process
• Stretch the skin and then bunch up the muscle
• Insert the needle at a right angle to the skin in the centre of the inverted triangle

Caution: This is a small site – give only 1-2ml or less of fluid in this site

• Prepare everything, ensure you have your syringe, drawing needle, injection needles and vitamin vile ready, along with your sharps bin.
• Open your syringe and drawing needle, keeping the packaging on where possible in order to not contaminate the needle.
• We recommend using a 21g Gauge drawing.
• Attach the drawing needle onto the syringe, leaving the protection cap on the needle.
• Open your vitamin ampoule. Break the top off the ampoule from the dot and dispose of the top.
• Take the top protection cap off the drawing needle and draw up from the ampoule the correct dose as recommended or suggested by your prescriber.
• Dispose of the single-use ampule, do not use any further product from it.
• Open the packing for your injection needle; we recommend the 23 Gauge needle.
• Take your syringe and untwist the drawing needle with the cap off, and put it in your sharps bin.
• Put your injection needle with packaging left on onto the syringe; once secured, remove the packaging and push up all the air out of the syringe until you hit your dosage marker on the syringe.
• Clean the injection area using an alcohol wipe once you have located it.
• Dart the needle into the muscle and push in relatively quickly.
• Press and wipe the area with an alcohol wipe and dispose of your injection needle into the sharps bin.