Vaping-associated illnesses raise cloud of concern about e-cigarettes, candy flavors and health impacts
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Dr. Allen Nord says e-cigarettes and good health don't mix

Before we get to my doctor and his worries about e-cigarettes, let me tell you about my niece and her ambulance ride.

She was terrified, trying hard not to faint. And she was perfectly healthy.

Her 18-year-old son, however, was awfully sick as emergency medical personnel transported him post-haste to the ER.

He had a spiked fever. He was struggling to breathe. And his oxygen saturation level, taken at urgent care before the ambulance was called, was at 85, which isn’t bad for a 95-year-old in hospice care.

But for an otherwise healthy almost-19-year-old preparing for his first semester of college? Not good. Not good at all.

Very dangerous, in fact.

He had been to urgent care a couple of times about his ailment. It was initially presumed to be viral, possibly developing into bronchitis. But when his condition deteriorated sharply, his parents took him back to urgent care and that 85-oxygen level showed up, it was a rush to the ER.

There he admitted he had been vaping during a stay at a lake with friends a few days before he got sick. At the hospital, he was given oxygen and related care. Eventually, the crisis passed and his vitals improved quite rapidly.

Now he’s out of the hospital, getting into the college groove and working with the Minnesota Department of Health to provide information on his illness and the vaping.

His parents and grandparents, including my sister and brother-in-law, are relieved and grateful. They’re also worried about how and why this sudden illness came on, and what role vaping played.

“Share this with anyone you like,” my sister, a retired nurse, wrote by email to me and her other siblings. “We are not ashamed and we want others to know.”

There’s certainly no reason for shame, and plenty of reasons for others to know. One of the first people I told was my family practice doc, Allen Nord, here in Rapid City. He’s a man in my age group with a powerful worry about the overall health of our nation’s youth, and in particular their smoking — or vaping — inclinations.

Nord was very interested and not very surprised when he heard about my sister’s grandson. He said there hasn’t been a confirmed case of similar lung problems connected to vaping here in South Dakota, yet. But nationally there have been more than 190 such cases.

And so far they’re a bit of a puzzle. A worrisome one.

“Antibiotics don’t seem to work. They’re now using high doses of steroids to treat them,” Nord says. “The cause is unknown. They don’t think it’s infectious. And all the cases were associated with vaping.

“Having said that, we know there are millions of young people vaping who seem to get away with it. So it isn’t truly a known cause and effect. But there certainly is a very close association,” Nord said. “We’re getting communications from the CDC as physicians to be on the lookout for this. The number of cases is going up and up and up, so something is going on.”

The Centers for Disease Control and Prevention is asking doctors to pose several questions when they treat a sick child or young adult with respiratory disease. The questions include: Have you been vaping? What’s the brand? Did you add anything to it?

Those who vape can add cannabis oil, for example, to the regular vaping oil or juice, which is made of water, glycerin, propylene glycol and nicotine. But there are indications that those regular ingredients might mix with flavoring could create new chemicals, some of which might be bad for the lungs.

“Of course, you’ve got all those flavors — mango, watermelon, Juicy-Fruit — that attract young people,” Nord says. “Plus there’s the perception that E-cigarettes are way safer than combustible cigarettes, so they are seen as a way to get the nicotine high without the dangers of smoking.

“However, we know that E-cigarettes have all sorts of toxins, so while they might be safer than combustible cigarettes, they are not safe,” he says. “That’s especially true for a child with asthma or similar breathing disorders.”

Research shows that heating coils in e-cigarettes can release lead, chromium, nickel and other toxic metals into the vapor, which is then inhaled. And Nord says tobacco-specific nitrosamines, potent carcinogens tied to lung cancer, are also in the mix.

The health threat from e-cigarettes has him thinking it might be time to revive the organized anti-smoking effort, through South Dakota Smoke-Free Kids and other groups, that he had been involved in against cigarettes.

“A decade ago, we were pretty proud of ourselves that we had conquered the young epidemic in smoking,” Nord said. “Then all of a sudden we started to hear about e-cigarettes and they are just exploding in use among young people. This may be the thing to resurrect those anti-smoking organizations.”

It might also mean that e-cigarettes will bring the ‘smoking” debate back to the South Dakota Legislature. Among the possibilities for legislative, Nord says, are taxing e-cigarettes like regular combustible cigarettes are taxed.

“Right now, the tax on these things is the same as a loaf of bread,” he said. “We could also increase the legal age for tobacco use to 21. Several states are now moving toward this and there’s even work on a bill nationally. But things nationally will take years and year to pass.”

Another possibility is putting limits on the flavors of e-cigarette oils that can be sold. Just this week, Michigan became the first state in the nation to ban flavored e-cigarette products. It’s a sixth month ban that Nord would like to see extended, and followed in other states.

“They’re not supposed to have flavors beyond menthol with cigarettes, but with e-cigarettes there are over a thousand candy like flavors,” Nord said. “Putting nicotine and candy together is just asking for trouble.”

It’s the kind of trouble that, so far in limited numbers, can send an otherwise healthy freshman in college on a frightening ambulance ride with his mother.

Or worse.