Jodi Reese awoke in an Iowa cabin a little more than a year ago with an excruciating headache.
She’d gone to the state park in northwest Iowa because she needed a break. A nurse practitioner, she worked for a local hospital and at a Council Bluffs homeless shelter.
She turned up the furnace, read and went to bed. The headache woke her the next morning. She was disoriented and nauseous, her vision blurry, her ears ringing.
She made her way down a hallway, found her cellphone and called a park ranger. That’s when she realized she was suffering from carbon monoxide poisoning.
The local fire department took her to an area hospital. She returned to Omaha and was treated in the hyperbaric chamber at the Nebraska Medical Center.
She went back to work with a lingering but manageable headache. Over the following weeks, her condition worsened — her brain kept getting foggier, her headache worse. She became more sensitive to loud noises and artificial lighting, and had trouble finding the right words and doing math in her head. Early last December, she left both her nursing jobs, afraid she would make a mistake.
“It’s been devastating not to work,” Reese said, “but I didn’t go into my profession to hurt somebody.”
Reese had suffered a non-traumatic brain injury.
While many people know carbon monoxide poisoning can be deadly, the fact that it can cause brain injuries — and with them, long-term aftereffects — is not as widely known.
“It is a thing, and it’s a thing that we are quite concerned about,” said Dr. Jeffrey Cooper, director of hyperbaric medicine at Nebraska Medicine.
The hyperbaric unit annually treats roughly two dozen or more patients for carbon monoxide poisoning, high-risk cases in which patients have lost consciousness or show symptoms such as confusion, seizures or loss of coordination.
Carbon monoxide, he said, prevents adequate oxygen from being delivered to tissues. But in some patients, it also can trigger an inflammatory response, in which the body attacks its own nervous system.
Sometimes the effects appear immediately. In others, problems manifest later.
Reese continues to have headaches and gets migraines. In the year since her carbon monoxide exposure, she’s undergone cognitive, occupational, physical and speech therapy. She now wears special glasses to correct her vision.
On the one-year anniversary of her exposure this fall, she gathered with friends and family and gave a talk about the dangers of carbon monoxide, giving them all carbon monoxide detectors and literature with more information.
Raising awareness about the preventable dangers of carbon monoxide has become a new mission, Reese said. She also wants to increase awareness of brain injuries like the one she suffered.
Medical literature indicates that between 30 percent and 50 percent of all poisoned patients will have long-term brain-related problems, said Dr. Lindell Weaver. Weaver is the medical director and division chief of hyperbaric medicine at LDS Hospital in Salt Lake City and Intermountain Medical Center in Murray, Utah.
There’s nothing to date that can predict which patients will have aftereffects and which will not, even with treatment, he said.
A randomized trial he and others published in the New England Journal of Medicine in 2002 indicated that hyperbaric oxygen therapy significantly reduced the frequency of aftereffects, both at six weeks and a year.
Hyperbaric oxygen therapy, in which patients breath 100 percent oxygen at more than 2.5 times normal air pressure, increases the dissolved oxygen in the blood, speeds the elimination of carbon monoxide and blocks inflammation triggered by the poisoning.
Weaver and several other experts have recommended that the treatment at least be considered for patients with serious cases of carbon monoxide poisoning.
But the key is to prevent carbon monoxide poisoning in the first place.
The colorless, odorless and tasteless gas can build up indoors from sources such as faulty furnaces, badly vented gas fireplaces or vehicles left running in attached garages.
Nationally, as many as 500 people die each year from accidental carbon monoxide poisoning, and more than 20,000 end up in emergency rooms due to its effects. Weaver estimates that the number might be closer to 50,000.
Nebraska in recent federal reports has ranked among states with the highest rates per capita of accidental carbon monoxide-related deaths.
Since Jan. 1, 2017, state law has required that carbon monoxide detectors be installed in all residences that are sold, rented or significantly renovated. The law was intended to prevent carbon monoxide poisoning in Nebraska homes. Landlords are responsible for installing detectors in apartments. However, the law doesn’t affect existing homes or apartments that aren’t sold or rented to new tenants.
A similar Iowa law took effect this summer. The two states are among 38 that require the detectors in private dwellings, either by law or through regulations, according to the National Conference of State Legislatures. Sixteen states require them in hotels and motels.
“The only way to save these lives or save these injuries is to have carbon monoxide detectors,” Cooper said.
Reese said she has purchased travel carbon monoxide detectors, which she lends to family members when they vacation.
The Iowa state park cabin where she stayed, she said, did not have a carbon monoxide detector, but the park ranger who arrived after she called brought two. Reese said both went off when he plugged them in.
Reese filed a lawsuit against the State of Iowa in October, seeking compensation for her injuries and for past and future medical expenses, alleging among other things that the state failed to maintain the furnace in the cabin and to have carbon monoxide detectors. The state filed a response denying her claims.
Reese plans to travel to Utah in January to participate in a trial that Weaver is conducting with people who’ve suffered brain injuries. Most have suffered the injuries due to trauma, but others had brain injuries resulting from heart attacks, infections or, like Reese, carbon monoxide poisoning.
The trial is intended to test whether additional hyperbaric treatments after the initial ones can reduce long-term effects for brain injury due to causes other than stroke.
Reese said she wants educating others about carbon monoxide to be part of her healing.
“I do not want what happened to me to happen to anyone else,” she said. “My life will never be the same.”