dissecting

I am an OR nurse which means many of my interests relate to something in surgery. Having scrubbed in and assisting surgeons for ten years really cements this tendency. At any rate dissecting tissue is fascinating me. One of my favorite surgeons with which I have worked is a Dr. Max Austin, a GYN/oncologist who always brought residents with him to the OR. Not only did I get to see the surgeries he did I also enjoyed hearing him explain to new doctors why he did what he did. I stood fascinated as he led his residents through each step of the procedure, and one part I found interesting right at first is the fact that he was always looking for "the plane".

"The plane" is the point where the obvious change between types of tissue occurs. Whether it be the layer of cells between the abdominal lining and the muscle of the uterus, or the muscle of the uterus and its lining these layers often are easier to separate if you can find the point where one begins and the other ends and begin to separate them there. I have since seen the principle apply to dissecting around gallbladders or prostates. The point at which such dissection becomes difficult is when a cancer has invaded the tissue surrounding the tumor. I have seen the tendrils of cancer tumors totally obliterate the normal planes leaving surgeons to guess where to dissect. When planes are difficult to find worse bleeding occurs and complications are more severe with surgery time being much greater. Another occurrence that makes finding the plane more difficult is scarring from prior surgery or disease.

As I looked over the last post it occurred to me that some may find it difficult to discern where I find the plane between truth and falsehood in health care. The fact is that I identified many poor health care choices that various family members made in a week of being together. At first glance it would seem that I simply rejected those practices that are not part of conventional medical practice. This is why I have been accused of being totally against alternative "medicine". The fact is that the plane between truth and falsehood is much more difficult to demonstrate.

Let's take, for example, the colloidal silver that my mom applied to every cut and burn and made everyone who had signs of infection take. I don't support the use of colloidal silver, but it is not because I know of an alternative "doctor" who prescribed it. In fact what happened is that my mother sent this colloidal silver liquid to me to prevent an infection in my family. Her statement was that taking a little silver every day prevented bacterial and viral growth in the body and kept one healthy.

My first thought was common- nothing can fix everything. It is true that many claims made by alternative health care practitioners regarding their wares cover everything from arthritis to cancer, but these claims have never borne much fruit. Consider this fact- if colloidal silver did kill every bacteria, then there goes the gut bacteria that help us make vitamin K. How about your skin bacteria that protect us from staph infections? Does silver taken orally kill off all the bacteria that give one bad breath?

Even though I know the claims made for silver may be a bit extreme I always consider the possibility that some truth may underlie the excessive claims. In fact studies done almost one hundred years ago supported the idea that ingesting silver molecules in liquid solutions reduced bacterial infections. The downside was that more then 3000 milligrams of silver were necessary daily to have that effect, and even so it was only a mild antibacterial that did not prevent pneumonia very well. This massive dosage of silver did have one obvious effect in that it turns the skin gray.

In my dissection of the facts from falsehoods in claims such as these I often start with recognized authorities. Many of my alternative |"medicine" friends decry such sources because they see it in the best interest of the authorities to suppress information that will support alternative "medicine". In my experience such authorities are a great place to start in research because they have history on their side and love to share it. In the case of silver the CDC, FDA, and EPA all had interesting articles that they published on the different risks and benefits of silver. In the case of a common item such as silver one of my favorite places to start is the EPA because they have files of MSDS sheets produced on such items which are used in industry. This is where toxic doses may be found. The EPA data was especially helpful in developing my information on ozone generators.

Back to silver. After finding that the official history of silver in medicine was less that sterling I thought I should see what additional claims were being made for those who sold silver. I found that Nature's Sunshine stated that their colloidal silver preparations had specially formulated silver molecules that are more bioavailable than older preparations. The question in my mind is now how much is necessary to have an effect? For this information I turned to Medline to find studies on local effects of silver preparations on infections. The studies I found reported that a fairly high concentration of silver was necessary to retard the growth of micro-organisms in any tissue. Even if the silver in colloidal silver liquids was more bioavailable the body would have to deposit enough silver in the effective area to essentially turn the area gray. Taking this much silver would have negative effects on helpful bacteria and cause many more health problems than it would help. As a side note none of the colloidal silver preparations have high enough concentrations that would have provided the necessary silver to have the desired and undesired effects. One would have to drink gallons of the the colloidal silver solution to gain any benefit.

But was there some truth to these claims? Technically yes. Silver solutions with high concentrations of silver molecules have been known to reduce the growth of bacteria in the lab. The question is whether the complex biologic systems in the body will allow silver to do its work. The most effective silver applications have been topical creams and silver impregnated dressings used for severe wounds or extensive surgical wounds. Short-term trial results have been mixed, but some people swear by silver dressings in the hospital. They are most effective at reducing the risk of infection in clean wounds, but don't seem to help already infected wounds. In my own experience silver impregnate creams are not as effective as triple-antibiotic creams. Oral silver whether colloidal or otherwise just hasn't lived up to its expectations.

So, in answer to those who say I dismiss all alternative "medicine" claims outright the answer is a qualified no. I totally reject palm readers and craniosacral therapy because the science just isn't there, but other claims I  look into because I often find something I can use in my own practice. I even research odd claims just in case. It is a matter of looking for the plane between truth and falsehood, and being alert for the sometimes very thin line.