Carbon monoxide from cigarettes causes oxygen debt

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Hello, dear readers, and welcome to a bonus letters column. Our mailboxes are filling up fast, so we’ll get right down to your questions.

  • We recently wrote about congestive heart failure, which is when the heart becomes unable to pump enough blood to meet the body’s needs. In discussing the role of smoking in developing the condition, we described how nicotine harms the body. A reader -- and fellow physician -- said we omitted an equally important factor: “You did not mention carbon monoxide, which is even more harmful to the heart,” he wrote. “You cannot separate one from the other.” Carbon monoxide, or CO, is a poisonous gas formed during the incomplete combustion of tobacco. Due to its chemical structure, CO binds to hemoglobin 200 to 300 times more readily than oxygen. That means with every inhale, a smoker sharply reduces the supply of oxygen being sent to the heart, lungs and other tissues and organs, and with each additional cigarette, keeps the body in a damaging state of oxygen debt. Thank you to our reader for this chance to revisit an important topic.
  • In writing about treatment options for cluster headaches, we mentioned oxygen therapy. Cluster headaches are a severe form of headache that occur in groups, or clusters. A reader living with this condition asked for additional information. “How might I find medical-grade oxygen canisters for home treatment of cluster headaches?” he asked. “My search thus far has been unsuccessful.” Medical-grade oxygen requires a prescription. Oxygen is a highly flammable gas that is delivered under pressure. Improper use can lead to an accident or to lung damage. With a prescription from the doctor who diagnosed your cluster headaches, you can receive the appropriate equipment, along with training, from a medical supplier. The prescription will also make it possible to seek treatment at a medical facility.
  • In a column about grip strength, which is the force generated by the muscles of the hand and forearm, we discussed its importance as a biomarker in older age. A decline in grip strength can indicate an onset of serious health conditions, including arthritis, osteoporosis, heart disease and cognitive issues. This prompted a question from a younger reader. “I’m 37 years old, healthy and a marathon runner, but in the past few weeks, I've had a harder time holding heavy weights for long periods of time,” she wrote. “I do have a history of MS in my family, but I have no other symptoms or issues. Should I be worried?” A decrease in grip strength in weightlifting can have a range of causes, including overuse, inflammation, carpal tunnel syndrome and even small changes to technique. If the weakness persists, the history of multiple sclerosis in your family makes it a good idea to check in with your doctor. MS is not an inherited disease. However, a genetic component does put family members at higher risk. Your doctor can evaluate your situation and help monitor any future changes.

Thank you, as always, for taking the time to write. We love hearing from you and will return soon with our regular monthly letters column.

(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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