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The Blue Man - Silver and Selenium

A Case Related by Pathologist Dr. Jerry Simmons, Sioux Falls, South Dakota

When a South Dakota ranch hand’s skin turned bluish-grey, his condition was initially diagnosed as methemoglobinemia, or reduced oxygen-carrying capacity in the blood. He didn’t respond to treatment, so he turned to the VA hospital in Sioux Falls, which is where Pathologist Dr. Jerry Simmons, working with a surgical resident, walked past the blue man and was intrigued.

“He was a smoker, and smokers do sometimes have a problem with methemoglobinemia,” Dr. Simmons explains the original diagnoses. “He was sitting in his hospital room and I happened to walk by the gentleman and said to the doctors, ‘he’s got silver poisoning.’ The internists all laughed when I told them, but we had a JEOL electron microscope so I said, ‘let’s biopsy him.’ The silver was off the wall and so was the selenium.”

Evaluation of a skin biopsy, using an electron microscope, revealed electron-dense, round particles around the sweat ducts, in glomerular basement membranes, and in tubular basement membranes. The deposits were shown to be silver selenide by electron microprobe.

Dr. Simmons knew selenium was abundant in certain parts of South Dakota, and selenium had been the topic of his prior research. At the University of Michigan, he was aware of selenium induced muscular dystrophy-like patterns of changes in the muscle tissue of rabbits. Upon moving to South Dakota, he worked with a researcher in California’s San Joaquin Valley to help determine the cause of deformities in baby coots and chickens. “There’s natural selenium in the valley, and when the farmers decided to irrigate natural pastures and grow crops instead of grass, the selenium got into the waterways,” he explains.

The natural selenium found in pockets of South Dakota also leaches into the drinking water. With a narrow toxic margin, selenium does provide an essential trace element that helps detoxify heavy metals and oxygen radicals. By attaching to the silver in the man’s system, it produced an inert compound, silver selenide.

Nature – in the form of selenium - had come to the rescue of the blue man, but he would remain forever blue. “The natural selenium in the ranch drinking water combined with the silver to prevent heavy metal damage.” The silver selenide would stay in his body.

“But we couldn’t figure out how the silver got there in the first place,” Dr. Simmons continues. After some discussion with the ranch hand, the doctor learned that he had been poorly fitted with dentures 12 years before. “Instead of going back to the dentist he went to the druggist who recommended silver nitrate to heal the ulcers in his mouth.” The build up of silver nitrate in his system had acted in the same way that it does when used in printing black and white photographs. Upon exposure to the sun while working on the ranch, the man “literally developed himself. He was a self-developed man in a way.”

That was the 1980s, and the use of silver nitrate for medical treatment was virtually outdated.

Most of the literature published about silver nitrate in case studies is quite old. “You’d have to go back and look at several older reported cases. Back in the twenties and thirties, there really wasn’t any other good treatment for syphilis so they used silver until penicillin came along. In the old days, grey-colored skin was a sign of someone who had been treated for syphilis.” Silver nitrate may still be used to control eye infections and blindness in newborns, however.

The ranch hand’s biopsies, which showed silver selenide in the liver and the kidney, proved what Dr. Simmons had suspected, and it also added to what he already knew about the benefits of selenium, which he believes contributes to certain types of cancer prevention.

There’s a narrow toxic margin. Typical daily doses range from 40 mg officially or 200-400 mg, for those who take it as a supplement or as a cancer preventive. If there is nothing for it to detoxify, or bind to, the body will flush it out.

Both too little and too much selenium in the diet can have detrimental impact. Dr. Simmons used research he had done in China as an example. “In one part of China where there is too little selenium, people were suffering from a strange heart problem. The problem was traced to a virus caused by a selenium deficiency in T-cells. In another part of China, there is too much selenium. Selenium salts have a red color. You can see it in dead cattle bones that have a pink tinge, or in corn crops.” The corn in a part of China where people were getting sick had a pink tinge, and it was determined that drying corn over a coal-fed fireplace, then spreading the ashes on the gardens, caused their illness.

In addition to selenium studies, Dr. Simmons’ research has focused on Environmental Pathology and Trace Metals; Neuromuscular Disease; GI Pathology; Lung Pathology; Pesticides; and Breast Cancer.

He is a Professor of Laboratory Medicine at the University of South Dakota School of Medicine, and has served as Medical Director, South Dakota Division of American Cancer Society and on the National Board of Directors, American Cancer Society.

As a seasoned electron microscopist, he notes that, “Electron microscopy has fallen out of favor for routine clinical work. Other types of tests are not perfect by any means so it’s nice to be able to do both. We do ours on a semi-research basis with an interest in muscle, nerve and skin in pediatrics.”

Recently, Dr. Simmons was consulted for “Forensic Files – Medical Detectives,” where he consulted on the Thyrotoicosis Case Study.

Despite retiring at the end of 2007, he looks forward to doing further research using immuno EM, where immunoperoxidase stains and immuno gold techniques will allow imaging of similar antibodies directly on the electron microscope to study Her2 neu in normal and malignant breast tissue.