Carbon Monoxide 2021

Carbon Monoxide

Carbon monoxide (can be referred to by its chemical symbol CO) 

 In a typical year, nearly 400 Americans die from carbon monoxide poisoning; this number might end up higher than normal due to the horrendous storms in Texas last week.

 Health officials reported that 450 carbon monoxide-related calls have been made statewide since Feb. 11th. Sadly quite a few of these cases were fatal. More people need to be aware of the risks! 

 How many of you own a carbon monoxide alarm? If you do, good for you. Make sure that it is in good working order. 

The units do not last forever. In some of the older units, batteries need to be changed annually (at least) and some units suggest that you vacuum the cover monthly to remove accumulated dust.

 If you are one of the many who do not yet own one, please remedy that immediately. 

It has been the law since January, 2013, with few exceptions. 

 Homes with a fireplace, attached garage, or any gas appliances are at higher risk, but there are many different factors that can cause an elevated level. 

A friend of mine is a lawyer who was involved in a heartbreaking case where a guest at a Bay Area hotel sustained long term health impairment from an exposure. 

The victim’s room was above the hotel pool and a faulty boiler used to heat the pool vented carbon monoxide into his room. When he didn't show up for dinner, his friends found him unresponsive. 

It was a very alert physician in the emergency room who figured out the cause. It was only at that point that the hotel was evacuated.

 This is not an isolated incident. As a result, my lawyer friend got in the habit of taking a portable detector along with him anytime he traveled! 

 Because heaters and fireplaces are often involved, exposure is usually higher during the winter months. In situations such as the one in Texas, people were trying to get warm anyway they could, and it cost lives. 

Outdoor appliances, such as grills, and even generators, need to be properly vented and should not be used indoors. 

If you have a generator as part of your safety plan (not a bad idea for earthquake or fire related power outages), it is essential to make sure that it is properly ventilated. 

 Carbon monoxide is a colorless, odorless and tasteless poison gas that can be fatal when inhaled. CO binds to hemoglobin with much greater affinity than oxygen, forming carboxyhemoglobin (COHb). It is hundreds of times more efficient than oxygen at attaching to the cells, so even small amounts can deprive our bodies of vital oxygen. 

In severe cases, for folks who survive an exposure, it can cause irreversible brain damage by starving the brain of oxygen. 

 Normally if someone is deprived of oxygen they may look pale or cyanotic (bluish); in the case of CO poisoning, the color will remain nice and pink. 

A standard pulse oximeter may not be an accurate indicator of where or not there is a problem. If carbon monoxide exposure is suspected, a specific blood test should be done to check the carboxyhemoglobin level. 

 One of our local ER docs who allowed me to pick his brain added that one of the tricky things about CO poisoning is that the symptoms are very vague and nonspecific. 

A faster than normal heart rate (tachycardia) is the only really reliable physical exam finding.

 Mild exposure might cause slight headache, nausea, vomiting and fatigue. 

This can easily be mistaken for flu or viral syndrome. 

Medium exposure symptoms would be a throbbing headache, drowsiness, confusion and a rapid heart rate.

 Extreme exposure will lead to unconsciousness, seizures, and cardio-respiratory failure that usually is fatal. The effects of exposure can vary greatly from person to person depending on age, overall health, and the concentration and length of exposure. 

Young children and pets are thought to be especially vulnerable. 

Pregnant women should also be especially careful because the fetus can be seriously impacted. 

 A carbon monoxide alarm is similar to a smoke detector because it monitors the air in your home and sounds a loud alarm to alert you of trouble. 

However, the way you respond to a CO alarm is very different from a smoke detector. 

When a smoke detector goes off, it is pretty easy to judge the level of danger. You can see or smell the smoke. 

On the other hand, because CO is completely undetectable to your senses, you are dependent on the alarm to let you know there is a problem.

 If the alarm sounds: 

 Operate the test/reset button 

Call 911 

Immediately move to fresh air (make sure that everyone in the household is accounted for.) 

Do not go back in until you have the ‘all clear’ from the emergency responders. 

 Concentrations of CO between 1 and 30 ppm can often occur in normal, everyday conditions. See the chart below for CO levels and corresponding symptoms. 

 If your unit is coming to the end of its life it may give off multiple chirps to notify you that you need to replace the device or change the batteries. 

Newer alarms might be good for as long as 10 years. The one that we have has a digital display that will signal when it is time to replace it. 

 My first experience with a Carbon Monoxide alarm was back in 2007. I was at my family home in Pittsburgh and my dad had died several days earlier. 

My sisters and I were all staying at the house when on that cold November night, we were woken up by a shrill alarm. 

We frankly had no idea what it was. 

After searching around a bit we found that it was the carbon monoxide detector going off. 

We weren’t sure of the correct action plan, but to play it safe we called 911 and huddled outside on the front porch until the firemen arrived. 

They went through the house with all of the monitors and everything seemed safe. 

Our best guess was that it was my physicist dad on the other side trying to figure out how things worked. 

I kid you not, the very next night the smoke detector went off for no apparent reason. 

Radios and lights were turning on and off. 

In our family, we just shrugged. That is going to be my next book. 

 After that encounter, I educated myself about carbon monoxide alarms.

 Several years ago when my daughter Alana was still living in Michigan, her CO alarm went off and she knew enough to get outside and call 911 immediately. 

After the fact she recounted her conversation with the fireman who had responded: 

 “I am worried about my cats, can you help get them out?” 

“What do they look like? 

“They are CATS, they are furry, have 4 feet and tails!” 

 Happily the kitties were all safely brought out of the apartment. The best guess for what set off the alarm was something faulty with the air conditioning system. 

It went off several times with no clear source identified, which prompted her to move to a different apartment. 

 You may not think that your home is at risk, but there is NO downside for investing in an alarm (plus you are complying with the law.)

 They are inexpensive.

 If you are renting and there is not a unit in your apartment, call your landlord immediately and get that remedied. 

In January of 2017, in the Bay area, there was the tragic instance of a young couple and their pets all found dead with no obvious cause. It turned out that it was CO exposure from a malfunctioning 3D printer. A functioning alarm would have saved their lives. Don’t mess around with this. Please make sure you are protected.

Do you know your love language?

Do you know your love language?

I may have many positive traits, but being romantic is not one of them. 

As is often the case, one half of a couple is more romantic than the other. It is rarely 50/50. 

My husband Sandy clearly carries the lion's share of the romance in our marriage. 

The poor guy is actually one of the most romantic men I know. How he got saddled with me is a question for the ages. 

 We often joke that Valentine’s Day is the one day of the year when he is grateful for the fact that my romance gene is missing. 

On that single day, when flowers and chocolates are doubled in price, there is no expectation that he needs to partake in this made up Hallmark occasion. 

But, in honor of the fact that Valentine's Day was this past week, I thought I would do a quick post about love language. Have you ever heard of it? 

This idea comes from a book by Gary Chapman, written back in the 1990’s. 

I first learned of it from my daughter Alana who refers to this concept in her work as a therapist. 

The 5 love languages that Chapman identifies are as follows: 

•  Words of affirmation 
• Physical touch
•  Gift giving
•  Quality time 
• Acts of service. 

Most people have one or two that resonate the most for them. 

The first step is figuring out how you tick. What works for you? 

Then think about your partner? How do you each need to receive love? 

How do you like to show it? Are you able to have a conversation about this and actually spend some time pondering and then take the next step which would be communicating your findings?

I know that many people (women in particular) would prefer to have their partner be a mind reader, but alas, that isn’t usually the way it happens. 

One example of this is: Your birthday is coming up. Your wish is that your partner would get you flowers. 

The implication here is that you want them to somehow know that. 

Once you have to tell them or ask them to get you flowers, the actual receiving of the flowers somehow is not quite as special as if they had thought about it on their own. 

Your partner might feel that they would be delighted to get you flowers, just ask. But the point is that you don’t want to have to ask. Round and round and round we go. 

This is basic relationship building stuff. 

I consider this valuable because anything we can do to help couples have positive and loving interactions is going to directly impact their children in more ways than I can count. 

Having a foundational conversation and understanding about what makes you feel loved is an excellent first step. 

This isn’t just about your partner. Try to understand where other people in your life, including your children fall on this list. Everyone is different. 

In her practice, my daughter Alana tells her clients that all love languages are valid, even if they do not resonate with you personally. 

The list is also not set in stone, it is just a basic guide. You may come up with something that isn’t considered one of the standard five main categories. 

 In the ideal and healthy relationship, we show love to our partners, friends and family members in the way they understand, and receive love back in the ‘love language’ that charges our battery. 

There is nothing automatic about this; as with most things in relationships, it takes a little bit of work.

My sister-in-law Barbara, a therapist and the author of Love in the Time of Chronic illness https://loveinthetimeofchronicillness.com, adds that you need to be deliberate and instructive about what you need from your partner. 

Because people often regress during times of stress, it would be great to have these discussions in advance and revisit them periodically. 

Keep in mind that your love language can change as often as your hair color. Circumstances change. The love language that you most relate to as a young single person can completely shift when you become a parent. 

Physical touch may no longer be what you are craving when you are breastfeeding and exhausted. Take the quiz!! https://www.5lovelanguages.com/quizzes/

Heavy Metals in Baby Food

If you have listened to any news these past couple of weeks, you have likely heard the story about the findings of unsafe levels of toxins in baby foods. 

What’s it all about? 

 Due to pollution, soil where the foods are grown can be contaminated with heavy metals.

 If you are a science nerd, the ones most commonly identified as an issue are lead, chromium, arsenic, zinc, cadmium, copper, mercury and nickel. 

These metals usually accumulate as a result of emissions from industrial areas, leaded gasoline and paints, some fertilizers, manures, sewage and pesticides to name just a few of the culprits. 

Even though we are no longer using leaded gasoline or lead based paints the damage has been done.

 Most metals don’t undergo degradation so they stay in the ground or water for a long, long time. Pollution in the air or water makes its way into the soil or into our rivers and oceans. 

When these toxins end up in the water, we can see this impact by measuring the levels found in the fish that we eat. 

 When they end up in the soil, they can be absorbed by food. 

Some foods are more susceptible than others. 

 At least we have started to make some changes here in this country. For example, we no longer use leaded gasoline and some industrial regulations have been put into place. 

The fact is that many of our regulations are too little too late. 

Even if our home grown foods were perfectly safe, which they aren't, many products are imported from countries who are not even beginning to enact any effective regulation. 

Trying to feed our children and ourselves clean food is stressful! 

 Knowing that we have issues with some of these contaminants isn’t new. 

Many people already limit certain fish due to mercury. 

We have been educated about the dangerous impact lead exposure can have on our children. 

We routinely get our kids tested to make sure the lead levels aren’t elevated. 

 Arsenic wasn’t something that most of us were paying attention to at all until the elevated arsenic levels in organic brown rice syrup created a media sensation several years ago. 

But it appears that even though concerns about unsafe levels were identified, current studies clearly indicate that not enough was being done. 

 To make things worse, many of the brands listed in these allegations are the ones that parents have counted on for generations to provide safe quality products. 

It is very frustrating that even with the changes that have been implemented, it is still evident that they were not enough. 

At the very least, customers should have been informed that mitigating these concerns was still a work in progress.

 I think it is perfectly reasonable to feel angry and betrayed. 

Go ahead; get good and mad. But then let it out and take a deep breath and release it. 

It is not helpful for you to hold in all that negative energy. 

Turn it into action. 

You can choose to no longer give these companies your business. 

Done! 

 What I wish you wouldn’t feel is guilt. 

Assuming your children have consumed some of these products, I am guessing that you made the best choices that you could based on the information that you had. 

We don’t know what we don’t know and we can’t manage the past, so as hard as it might be, please forgive yourself. 

 I think that it is actually very beneficial that this information is surfacing so that we can make healthier choices moving forward. 

See if you can take any anxiety that you are feeling and channel it into a resolve to take positive action.

 What choices can you make now that you have this information? 

 Alas, while going organic can minimize pesticide exposure it doesn’t have much impact on the heavy metals. 

 Pay attention to the biggest culprits. Rice cereal is one of the biggest offenders. Brown rice has some nutritional advantages but white rice is the safer option. 

The heavy metals absorbed into the food from soil are going to impact the surface of the food the most. White rice is processed to remove that outer bran layer. 

If you are cooking your own rice, start with a little more water than called for and then do an extra rinse. This can help decrease potential toxins significantly. 

Rice has nutritional benefits and by no means needs to be completely removed from your diet. 

As I have been saying in my solid foods class for years, some amount of rice cereal is fine, I just wouldn’t give it daily. 

Variety is beneficial. 

Be a label reader - organic rice syrup is an ingredient found in many snacks. 

 Sweet potatoes and carrots are two popular veggies that have been found to absorb the highest amounts of the heavy metals. They still have some worthy nutrition, I certainly think there is room for them in a healthy diet. 

Just like the rice, the outer part is going to be the place that has absorbed the highest level of the metals. Deep peeling can help a lot. 

 Fruit juices are also on the list. This one is easy. No kid really needs to be drinking juice. That being said, of course, the occasional bit of juice is not something to stress over. 

 Certain nutrients may offer protection. 

Antioxidants can help prevent absorption of toxins. 

It has been well documented that lead doesn’t absorb as well if a diet is high in iron and vitamin C. 

This is true for the other heavy metals as well. 

 Making sure that you give your kids adequate fluids is great for flushing out the system. 

 Variety is important. 

Make sure you switch things up and offer a large assortment of foods, rather than eating the same thing over and over.

 In conclusion, I don’t know of many adults who got through their childhood without partaking of these same products, and we all seem to have survived. Having some exposure to these heavy metals is not ideal, but at a mild to moderate level it is absolutely not something I want you to panic about. We can’t live in a bubble (although during covid, some of you might dispute this.) As with all things, simply do the best you can. If you like more data on this subject, check out this article written by my colleague, the wonderful Dr. Ted from Oath.

Covid/ One year later

It was a year ago that I was doing my first post about COVID. Always with an ear out for items in the news that could cause worry for my patients, I was on alert. Over the years it was not unusual for a virus to circulate that made the news. Measles outbreaks, West Nile, Ebola, Zika, even one called enterovirus D-68 that most of you probably don’t even remember (that one was a cousin to Polio and caused some paralysis). These were terrifying, but in terms of actual threat to our Bay Area families, were soon enough in the rear view mirror.

If I ever claim to have some psychic abilities, that ESP was nowhere to be found when it came to covid. At the very least, I would have bought extra toilet paper. My initial covid post from last year warned families to be prepared in the unlikely event that we might need to do the unthinkable and quarantine for a couple of weeks. Wow, what a difference a year makes.

So many of us had plans to travel, tickets to shows, weddings and events on our calendars. It was unfathomable that everything would be put on hold, but 2020 put us in uncharted territory

It is fair to say that we have found ourselves in a brand new landscape.

• The horrors of the shocking numbers of cases, deaths and chronic consequences.
• The staggering economic hardships of so many people who have lost jobs and livelihoods 
• Frightening number of people who maintain that the virus is a hoax...WTF!
• The isolation of people who are living alone and the sadness of family and friends who are not able to be together.

Sigh.

For anyone reading this, congratulations on making it through a very difficult year. For all of the difficulties and sadness some moments of light have floated through.

Zoom...who had even heard of it? Yes we can all get zoom fatigue, but I have had routine zoom sessions with friends and family near and far. Now I gather once a month virtually with my 98 year old uncle and cousins. More and more extended family members join in the call and it is lovely. We fill our screens with old family photos and take advantage of uncle Melvin’s remarkably sharp memory while he identifies the people in the pictures and regales us with tales.

Working at home in your pajama bottoms and bare feet.

Your pets are thrilled to have you around all day.

Many people have taken up new hobbies. The tap dancing classes that I took from a friend only lasted for several weeks, but I have been playing piano more than I have in years. My son-in-law Adam has perfected his sourdough bread!

Flu numbers are unusually low for this time of year. Pediatrician’s offices are seeing way less of common colds and viruses. No doubt this is in part thanks to the social distancing, masks and hand washing.

So what’s next?

The promise of vaccination is already here for many, and within the next several months for many more. It will no doubt take some time to get everyone protected but at least there is some hope in sight.

While we are making progress, this is the proverbial two steps forward, one step backwards. Alas, as promising as the vaccine is, covid is a wily virus and new strains are popping up. Some of those newer and more contagious strains have recently been identified in the Bay Area. Until there is herd immunity, even with the vaccination, wise people will continue to mask up and continue with social distancing until the public health experts spread the message that we can get back to normal. We simply can not afford to get quarantine fatigue.

Here are some of the quarantine related blog posts that I have done this year:

https://nursejudynvp.blogspot.com/2020/03/managing-quarantine.html

https://nursejudynvp.blogspot.com/2020/03/assessing-our-priorities-in-this-time.html

https://nursejudynvp.blogspot.com/2020/04/tips-for-dealing-with-too-much.html

https://nursejudynvp.blogspot.com/2020/04/finding-humor-in-this-time-of-quarantine.html

https://nursejudynvp.blogspot.com/2020/06/stop-feeling-fuilty-for-finding-moments.html

https://nursejudynvp.blogspot.com/2020/06/decisions-about-how-to-ease-out-of.html

https://nursejudynvp.blogspot.com/2020/07/talking-to-your-kids-about-germs.html

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