As an ICU doctor I live in worst case scenario land. I think people often think something’s not harmful because they see people doing it, and they’re not dropping dead that very second, so they think they can’t be that bad. In my world, I see everyday when that cigarette finally causes the heart attack or the stroke or the flare of asthma or COPD that puts someone on life support or ultimately kills them. I see when people have severe lung injury from e-cigarettes and vaping. I see when a 30 year old using an e-cigarette has an out of control lung infection whereas another 30 year old without vaping-induced immune system lung damage would probably have fought off that same infection. For some reason I think it’s just really hard for people who don’t work in healthcare or know somebody directly affected to believe that these things cause harm. So for the first episode of Season 6 of Air Health Our Health, I talk to Petrea McKeithen who started using nicotine containing flavored e-cigarettes in her early twenties and can provide a first person account of surviving a near death experience from her flavored e-cigarette.
EVALI is E-cigarette and Vaping Associated Lung Injury. It actually likely represents a multitude of severe inflammatory reactions that have a final common pathway of severe lung scarring. Petrea developed this severe lung injury and ended up on something called ECMO which is extracorporeal membrane oxygenation which is the most aggressive form of life support we have in the ICU. Not every Intensive Care Unit can do it. The ICU team takes someone who is usually already on a breathing tube and paralyzed and hopefully deep in a medical coma so they’re not feeling things, and then takes large catheters and inserts them into major blood vessels in their body – usually into a large vein that goes into the vein going to their heart from above in their neck and potentially another in the main vein in their leg. We pull blood out, run it through a machine to put oxygen in and then put that blood back in. You can imagine this is dangerous and people often have very long ICU stays after being on these machines, followed by long hospital stays recuperating and then also from covering coming back psychologically from the multiple mind-altering medications they end up receiving. It is not trivial and it is not clean.
My guest is very open and honest in this episode about the impact an ICU stay can have on an individual and their loved ones, even years later. As people increasingly survive the ICU themselves or have a loved one who has, these stories are important to hear. She describes intense and traumatic dreams that still haunt her as well as ongoing effects from lung damage.
I am blown away by Petrea’s courage in sharing her story. One of the things that is so hard when I care for people who are victims of the tobacco industry is often a deep sense of shame. Many know that these things are not likely healthy, but just can’t believe that these things would be legal and sold everywhere if they were so dangerous.
This last year my home state of Oregon considered joining other states in banning flavored e-cigarettes and flavored tobacco, especially menthol. A legislator who was a pediatrician led the charge. Unfortunately it did not pass- you can imagine there was a lot of pushback from the tobacco industry and from those who make money selling these devices. There was a consistent narrative that “adults should be able to do what they want,” and also those who said that this was not a problem from e-cigarettes but only from vaping marijuana, which we know is not true. For those who accepted that there may be harm, they noted that if people over 21 want to risk their health they should be able to. I struggle with this as an adult doctor because I care for my patients and I don’t want them to destroy their lives, and there are tons of products that can be very harmful that we don’t make legal to sell in inhalational forms with candy flavors.
Whenever I see a case like this caused or worsened by tobacco, it just blows my mind that these things are legal. I often think about about a stroller I wanted for my baby’s car seat that everyone said was the best one, but it had gotten recalled because a child had had the tip of their finger injured. I just think it’s wild that throughout the country at gas stations and corner stores we sell these devices flavored to attract new users that can put someone on ECMO. Combustible cigarettes are deadly, and if it helps to have non-flavored e-cigarettes available to help people quit, I certainly support that, but nobody needs banana ice out there destroying Petrea’s life.
Another thing that came up in our conversation is how devastating receiving care in the Intensive Care Unit alone can be. I work with amazing professionals in the ICU, and we all work hard to minimize the harm of our care. However, even with the best care, critically ill people are having tubes pushed into their lungs, between their ribs; they are having often large catheters inserted into their blood vessels, and their body experiences that trauma even if later they know it was to save their life. People can have true Post Traumatic Stress Disorder, so if you have gone through this or a loved one there are some resources to help. I often send people to ICUdelirium.org, which focuses not only on the delirium but the severe dreams and cognitive changes that can come following Intensive Care Unit as well as other elements of what we call ICU survivorship. Obviously those of us who work in the ICU will continue to look for ways to decrease the side effects of the care we provide, but the best thing we can do to prevent PTSD from ICU care and all the downstream things that are still affecting Petrea, is to prevent anyone needing the ICU in the first place. That is the mission of Air Health Our Health, so thank you for listening to today’s episode.
So what can you do?
- Find out if your county or state has a comprehensive flavored tobacco ban. You can learn more about why this is important in the “Breaking States Free from Flavored Tobacco and Why it Matters” episode from Season Five.
- Look back through the Air Health Our Health podcast feed and blog for a host of episodes on the history and chemistry of menthol, of flavoring chemicals, of targeting kids, etc.
- Look up who represents you in your county or state and reach out to them asking about what they intend to do to make flavored tobacco harder to obtain.
- If you or someone you know has gone through a stay in the ICU, learn more about potential after effects at ICUdelirium.org and how you can support them both during their ICU stay and afterwards.
- Consider a donation to the American Lung Association or the Campaign for Tobacco Free kids
Images courtesy of Petrea, from my clinic, or from American Lung Association
That is a story that may have more of an impact than just telling kids statistics… I am giving an outreach talk weekend, would it be ok to share the story and include some pics, with attribution? I found especially the part about her quantifying the number of hits she was talking interesting. I suspect from my own experience that there is a subgroup of people who are both more susceptible and more intense users. After all, vaping is extremely common, and ICU admission for it isn’t – even at the height of the vitamin E related EVALI “epidemic”.
I think that is likely- she has shared the pod on her social media, and you could likely get in touch directly. I also think there are a great deal of underreporting and unreported cases or more severe “pneumonia/ARDS” episodes in vapers/Ecig users that are attributed to pathogens, etc, but that may be more fulminant in those regularly vaping or using e-cigs.