Cold Foes

Although we had a brief respite, we should be back to near-zero low temperatures by the time you read this.  Winter presents some unique health hazards – CO and frostbite! CO is carbon monoxide (not to be confused with carbon dioxide, CO2). CO is the product of combustion. Combustion can be found in anything burning most fuels, including motor vehicles, gas stoves, furnaces, wood fires, charcoal fires, and even small gasoline engines that might be used to power a generator. With windy, extra-cold conditions, not only is the need for adequate heat great, there is also a good chance that power lines may be disrupted causing a loss of heating, water pump operations, and other electrical necessities. Loss of power or heat might prompt one to use a gasoline-powered electrical generator, kerosene stove, wood burning fireplace etc. and present the risk of CO poisoning.
To complicate things, CO has no odor or color to help us detect its presence. Frequent symptoms of CO poisoning are headache, dizziness, chest pain, or confusion and might easily be confused with other problems and the real culprit of CO can be easily overlooked until it’s too late.  CO can cause sudden illness and even death without warning.
How does CO poison us? Our red blood cells are full of the protein hemoglobin (HgB). HgB is what carries oxygen from our lungs to our tissues, including the heart and brain. Unfortunately CO also sticks to HgB, and CO sticks to HgB even better than oxygen. Thus if CO is around for us to breathe, our HgB will quickly become full of CO with no room to carry oxygen. Our tissues need oxygen to stay alive!
CO is one of the leading causes of poisoning death in the U.S. (5000-6000/yr) and 40,000 emergency room visits, yet it’s preventable. What can we do to protect ourselves and minimize the risk of CO poisoning?  Battery-operated CO detectors are available, but prevention and minimizing risk should be our first approach. Have all appliances checked by qualified service persons, especially your furnace. Only buy appliances that have been approved and bear the seal of a national testing company. Don’t operate kerosene stoves inside closed spaces or use catalytic converters inside. If you use a gasoline-powered generator, make sure it’s placed far enough from your home and any windows to prevent the exhaust from getting inside (follow manufacturer’s instructions). Don’t use gas cooking stoves to heat your house when the power is out. Never burn a charcoal fire indoors. Your vehicle also represents a risk of CO poisoning, especially if you are sitting in the cold with the engine running. If this is necessary for more than a few minutes, open a window. If you operate a vehicle with a tailgate down, open other vents because an open tailgate will allow exhaust fumes with CO to come inside. Tempted to remote-start your vehicle? Only use remote start if your vehicle is in the clear outside or, if inside a garage, make sure the garage door is open.
Frostbite — This is an insidious problem that we’ve all heard about but tend to minimize our risk. We think, “I’ll only be outside a few minutes.”  Television announcements on a recent subzero day warned us that exposed skin was subject to frostbite after only five minutes. People with reduced blood circulation are at increased risk. Frostbite often affects the nose, cheeks, fingers, and toes, and affected areas lose their feeling and color. Early signs are not always recognized by the person that is being affected because they have no feeling in the area. If you think you have frostbite, get into a warm room or vehicle immediately and seek professional medical care. Don’t use a heating pad. You can use body heat as in placing cold fingers/hands in the armpit(s). You can place the affected area in warm (not hot) water. Don’t massage the area, as this can cause more damage, and don’t walk on frozen feet/toes if possible. Frostbite can lead to the death of tissues, need for tissue removal and even amputation of affected parts. Wear gloves, boots, face protection, and an adequate winter coat if outside in freezing weather. Although spring is coming, old man winter is still here for a while — Stay safe!

Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (which is closely affiliated with Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com