A CARBON MONOXIDE UPDATE (Periodic Newsletter on CO)

Vol. 2, No. 2a
December, 2000

  • I get so much mail, E-mail, FAXs, phone calls from people all over the world regarding carbon monoxide - approximately 6-10 every day. I estimate that I am now "seeing" more people poisoned by CO than anyone else in the world. COHQ and its satellite (CarbonMonoxideHQ.com) certainly are visible on the internet! I am very pleased with this and hope that they, and I, can be of continued service to you. As you may already know, I am also answering medical / scientific questions about CO at carbonmonoxidekills.com - I thank that website for inviting me to be "the Doctor is in".


    Can you refer me to a doctor? - One of the most frequently asked questions is: "can you give me the name of a physician in my area who is knowledgeable about CO poisoning?" Unfortunately, I do not keep a database on thousands of physicians, even in the United States. The other problem with this question is that most physicians know little about CO poisoning - this is even more true for chronic CO poisoning. If you wish to have your symptoms treated (headache, dizziness, muscle/joint pain, depression, etc.) your physician SHOULD NOT have to be an expert on CO poisoning to do this. He/she can simply treat the symptom(s) by prescribing the appropriate medication (analgesic, anti-vertigo med., anti-depressant, etc.) to alleviate your suffering. Does this make sense? It is my approach to refer patients for the proper specialized evaluation following CO poisoning. This usually involves having them see a competent neuropsychologist (a Ph.D. person like myself), one experienced in the effects of CO.

    Is going to a physician the best way to get a health condition resulting from CO poisoning diagnosed? - This question is closely related to the one above. Generally, physicians are very reluctant to make a diagnosis of CO poisoning, due to their lack of training and experience in the area. Finally, as I comment on below, visiting many physicians to obtain a diagnosis of "CO poisoning" is not usually wise if you are seeking compensation in the courts. Most physicians will come up with an alternative, to them, more likely diagnosis (high blood pressure, psychiatric problem, pulled muscle, etc., etc.), that will be, to say the very least, unhelpful in a court battle. Neurologists are often consulted in CO cases. Unfortunately, few have any training in toxicology. Moreover, the "Gross Neurologic Exam" that they use does not have the power to ferret out the residual effects of CO poisoning or to objectively quantify them. If you need that physician's records for your court case, what he/she says could help you, or more likely, hurt your case. That is where an expert in CO poisoning is called in to analyze the situation and render an educated explanation of cause and effect for the health damage that has occurred.

    How long will the effects of CO last? - This is another very frequently asked question. Doc, "how long will it be until I recover to my healthy pre-CO-exposure state?" Recovery time from CO poisoning is extremely difficult to predict, at best it is usually very slow, and recovery is often minimal/partial. I have spoken with people who continue to have debilitating symptoms from CO poisoning 10 and 15 years after the incident. The major portion of the recovery that occurs takes place during the first 9-12 months after termination of CO exposure. If you were actually able to choose your brain trauma, stroke or concussion in a motor vehicle accident is probably better than CO in terms of longterm recovery and outcome! The brain is usually better able in time to "wire-around" localized lesions produced by stroke and concussion than it is the diffuse damage that CO produces.

    For more information on chronic CO effects, take a look at COHQ/ChronicCO/StudyB/StudyB1.htm, or COHQ/COSupport/symptomscosup.htm

    MINI-QUIZ: Would you answer TRUE or FALSE?

    1) Cracks in heat exchangers are usually responsible for the production of CO T or F

    2) Breathing "clean" air for 2-3 hours will eliminate all CO from the body T or F

    3) Everyone responds to CO in the same way, ie. show the same symptoms T or F

    4) Depression and personality change seldom result from CO poisoning T or F

    5) High-tech imaging devices (CT, MR, SPECT) always show areas of brain damage from CO poisoning, if it exists T or F

    6) Neurological evaluation is the best diagnostic approach to determine the extent of CNS damage caused by CO T or F

    7) CO exposure never produces brain damage unless there is a period of unconsciousness T or F

    8) People who recover from CO poisoning are always completely normal T or F

    See the answers below

  • Buy the New Book on CO - CARBON MONOXIDE TOXICITY, by D.G. Penney, Ph.D., CRC Press, 2000. GO TO COBook2.htm


    The following is a "Check List for Victims of CO Poisoning Who Wish to Seek Compensation"
    Infomation Sheet 101, Version 2.0, Dec. 1, 2000

    1) Fill out a new Diagnostic Carbon Monoxide Questionnaire available on-line (COHQ/COStudy/coStudy1.htm) or get the NEW EXPANDED vers. 6.2, qualitative and quantitative, CO Questionnaire directly from the author, and mail/FAX it to Dr. D.G. Penney (1209 West Twelve Mile Road, Royal Oak, MI 48073 / 248-547-4634). Also, ask about the Adult History Questionnaire and CO Source/ Measurement Questionnaire.

    2) Do not allow the CO source (furnace, water heater, etc.) to be removed/replaced. Keep the evidence! Do not sign any papers waiving your rights if a party offers to install a completely new unit. MOVE QUICKLY or you could lose an important piece of leverage in your case.

    3) As of RIGHT NOW, develop a chronology of what happened and how you felt during and after the exposure. Be as detailed as possible and attempt to afix exact dates as to when specific things occurred.

    4) Do not assume that because your physician(s) can find nothing wrong with you or members of your family, that you are/will be ok. The effects of CO poisoning can be and are, usually quite subtle, especially the effects of chronic CO poisoning. Individuals exposed, or their loved-ones, are usually those who notice the deficits and changes first. Again, use of a CO Questionnaire at this point is a highly recommended.

    5) Unless you are looking for a "cure" only, DO NOT visit one physician after another looking for help. Many physicians know little about CO poisoning, especially chronic CO poisoning and its after-effects. Establishing a trail of medical records with practitioners who know little about the condition and who cannot testify to the seriousness of your health deterioration can only damage your case in settlement negotiations and in court.

    6) Seek out an expert on CO exposure/poisoning who can guide you and your legal counsel in WHAT and WHAT NOT to do in developing your case. Obviously, this professional should have a long experience with CO poisoning and its consequences.

    7) Gather all the relevant documents in your case:

  • CO levels measured at the site of exposure.
  • Photographs, maps, drawings of the site, comments of witnesses, etc.
  • Carboxyhemoglobin levels in blood drawn within 2-3 hours of leaving site of exposure.
  • All relevant medical records prior to, during, and after the exposure. Prior to records should generally extend back 4-10 years before exposure.

    Impotant: Keep photocopies of all original and other records you distribute to your attorney, experts, etc.

    8) Select your legal counsel with care. He/she should have a track-record in personal liability and/or toxic tort law. He/she should be very interested in your case and willing to give it the attention it deserves. The first interview with attorneys is free - use that time to determine whether he/she is right for your case. It may be necessary to have your CO expert do a preliminary review of your case and a brief report in order to convince your attorney that the case has merit. If he/she is still not really interested, seek elsewhere.

    9) In most cases decline physicians requests that you undergo high-tech scanning studies such as CT (CAT), MRI, SPECT, PET, etc., especially if your exposure was chronic and at a non-lethal CO level. Such studies are usually negative and only provide arguments for the defense. Under some circumstances, however, studies involving MRI, SPECT and PET are justified. Consult your expert first.

    10) Consider the possibility of doing a "re-creation". That is, under controlled conditions with the well-planned monitoring of gas conc., set up the site of exposure as identical as it was during your original expos-ure. Your expert on CO should be a member of the team who plans the re-creation. Remember that all data from such a re-creation is discoverable by the defense and a poorly done re-creation can work against you. I will be happy to advise you in how this should be done.

    11) Neuropsychological evaluation data are KEY to demonstrating damage from CO poisoning. A neuropsychologist is not a physician, but rather a Ph.D. psychologist with special training, who objectively measures loss of brain, motor, and sensory function by administering many tests over a period of hours. It is very important that you hire the correct neuropsychologist, one with previous experience with CO poisoning victims. I will be able to make referrals to the best of such professionals.

    12) When assembling a packet of documents for your attorney or experts to review, organize them carefully, labelling each sub-group for easy access. Remove duplicate documents coming from different sources (eg. doctors' offices), as this requires more time of the reviewing party and increases the cost to you. Well-organized documents will work strongly in your favor.

    13) For answers to other questions relating to your case, contact me immediately - use the E-mail address below.

    Mini-Quiz Answers: All items are FALSE

    Direct all mail to
    Dr. David G. Penney
    E-mail dpenney@cmb.biosci.wayne.edu

    to COHQ (USA)

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