Crozet Annals of Medicine: A Bad Case of the Blues

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One of the ER techs sought me out recently and found me taking some executive time at my computer reading the New York Times on line.

“Dr. Reiser, the triage nurse is asking for you to come out front and see a patient. She is worried that the patient may be very sick.”

Now I hate to go out to triage for many reasons, but I do have a hard and fast rule that I teach my residents: if a nurse asks you to come see a patient, you drop what you are doing and go. 

So while I frowned and hemmed and hawed, I reluctantly agreed to come. I had little choice really; both my senior residents had heard of the sick patient and were heading out front ahead of me. They love the challenge of caring for sick patients.

The triage nurse intercepted us.

“This guy is really cyanotic. The last guy I saw who looked like this had a giant saddle embolus and coded right in front of us. We couldn’t get him back.” 

Cyanotic means blue-colored and a saddle embolus is a large blood clot in the lungs that straddles both pulmonary arteries where they meet in the center of the chest. It looks a little like a saddle. A saddle embolus blocks blood from getting to the lungs and getting oxygenated. It is the non-oxygenated blood that turns blue and produces the characteristic cyanotic skin color seen in saddle emboli. 

We picked up the pace a little and arrived at triage to see the patient sitting up in a chair, bluer than the guys in the blue man group. I have before never seen anyone that blue. He was actually a kind of greyish blue, almost metallic appearing. I flashed on the Tin Man from the Wizard of Oz.           

And yet it was weird, he was amiably chatting with a tech and his daughter looked on unconcerned. His vital signs were normal with the exception of his heart rate, which was low at 40 beats per minute (72 is normal). He had no shortness of breath or chest pain, making saddle embolus unlikely. 

The residents picked up on the other weird and telling abnormality, the whites of this man’s eyes (sclera) were also blue. The sclera does not have any blood supply and so does not get cyanosed from low oxygen levels.

One resident asked his daughter if his face always looked like this. She peered at him and said sure. She didn’t seem to notice his peculiar color. 

The other resident asked if he was on amiodarone, a heart medicine that can occasionally color the eyes and skin blueish. “Nope” was the answer.

Lay people would probably be surprised by how often in the ER we surreptitiously exchange baffled looks with each other and this was one of those times. 

Then his daughter volunteered that he did regularly use colloidal silver drops for his arthritis. She herself was taking it to treat a tooth abscess. 

This brought sudden knowing smiles to the residents and myself, also something we often share surreptitiously. Mystery solved by a piece of medical arcana, a dusty factoid from medical school I hadn’t thought of in 30 years. 

Argyria is a grey-blue discoloration of the skin caused by the accumulation of silver particles in the skin. I had never seen it because silver, once widely used as an antimicrobial had gradually fallen out of common medical practice starting in the 1940s with the onset of more effective antibiotics. Curious, I asked her where she got it. I was picturing some fringe alternative medicine site. “Amazon, of course,” she replied. Delivered right to her doorstep. 

Argyria is a grey blue discoloration of the skin caused by the accumulation of silver particles in the skin.

The last time I had used medicinal silver was on my obstetrics rotation in 1988. We put silver nitrate drops in the eyes of all the newborns to prevent gonorrhea and chlamydia eye infections. It worked well, but we now have less toxic antibiotics we preferentially use.

The use of silver in medicine and public health dates back at least to the time of Hippocrates. Silver is a potent antiseptic and has been and continues to be used for water purification, topical wound care and impregnated in catheters and tubes to prevent infections. But ingesting it orally, as my patient was, has no accepted medical indication or use.

Because I hadn’t used medicinal silver in so long I looked it up on the internet to see what I could find out. I was surprised to find a robust offering of silver-containing dietary supplements from many companies. Amazon has twenty pages of colloidal silver solutions including formulations for your pets. But what does it do?

According to the internet, colloidal silver is effective in treating over 650 infectious diseases, has no adverse side effects, and is effective against arthritis, blood poisoning, cancer, cholera, diphtheria, diabetes, dysentery, gonorrhea, herpes, influenza, leprosy, lupus, HIV/AIDS, malaria, meningitis, rheumatism, shingles, staph infections, strep infections, syphilis, tuberculosis, whooping cough, and yeast infections.

The FDA disagrees. It is illegal to market these formulations to treat any disease or condition. There is not a single study that supports any benefit of colloidal silver to treat any medical condition and substantial evidence of harm. But silver can be sold as an over-the-counter dietary supplement as long as no claims like the above are made. 

The popularity of colloidal silver seems to have mirrored the rise of the internet. Interest began in the early 1990s and is now trending all over the web. Tens of thousands of people have embraced this quackery and ingest harmful amounts of silver every day. I had no idea.

Silver has no known function in the human body and is not a nutrient, essential vitamin or co-factor. It can only hurt you. It does not just accumulate in skin and sclera; it infiltrates most bodily tissues including nerves, kidneys and hearts. In fact my patient’s initially low heart rate eventually slowed down so much that he required the surgical insertion of a permanent cardiac pacemaker. 

And his argyria, the blue skin discoloration, is irreversible. Apparently it’s one of the few things colloidal silver can’t cure.  

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