GRAND FORKS — Jim Schnack and his family had the scare of a lifetime when his high school-aged son recently was hospitalized for four days due to lung damage caused by vaping.

The teen was admitted to Altru Hospital in Grand Forks after complaining of trouble breathing and pain under the rib cage, the latest in a series of symptoms he had brushed off.

In the hospital, “my son was the only one who did not comprehend this is vaping related,” said Schnack, who agreed to visit with Forum News Service but asked that his son, who is a minor, not be named. “The doctors explained everything to him and showed him the CT scan. When they said, ‘You damn near died,’ he finally got it.”

For more than two years, his son denied vaping and hid his habit well, he said.

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“These pods are so small you can easily hide it. These kids are very resourceful. Unfortunately, it nearly cost my son his life,” Schnack said.

The medical team was close to a decision to airlift the teen by Medivac to Fargo for more specialized care, he said. The boy is improving, and now Schnack wants to warn other parents and teens about the potential life-threatening effects of vaping.

When his son was hospitalized, “I contacted every parent I knew that had kids who are vaping,” he said. “I want people to know it’s happening here, and it’s happening now.”

The parents were shocked, he said.

“You just don’t know. I’m scared, angry and worried. It’s a huge problem.”

His son was vaping with products available at any gas station, Schnack said, noting that he is pleased a new federal law has made it illegal for anyone younger than 21 to purchase tobacco.

For more than two years, Schnack had had no luck convincing his son of the dangers of vaping. The warnings were “white noise” to his son, who refused to believe vaping could endanger his health, Schnack said.

But it did.

“To think I almost lost him,” he said in a recent interview.

In the hospital, the teen was put on oxygen as the medical staff worked to stabilize his heart rate, oxygen and body temperature, Schnack said. Only when doctors began to treat his condition with steroids, rather than antibiotics, did his condition begin to improve.

There are not enough case studies for physicians to completely understand this illness, Schnack said. “Doctors told us, ‘We’re learning from your son.’ ”

Spike in cases

The spike in vaping-related illness and deaths last summer grabbed the attention of the medical community nationwide. The CDC has reported more than 1,800 cases of lung injuries due to the use of e-cigarettes, or vaping, in 49 states as of Oct. 29. Fifty-two people nationwide have died from vaping-associated illness, said Dr. Antranik Mangardich, pulmonologist at Altru Health System.

Last summer, the age of individuals being diagnosed and the lack of coexisting health problems — as well as their need for “very invasive treatment” — caught the interest of medical professionals and researchers, Mangardich said.

Millennials and teens have been affected the most by vaping-related illnesses, experts say. The vast majority of these cases — nearly 80% — have been in users younger than 35. Specialists have pointed to vaping oils that contain THC, the psychoactive ingredient in marijuana, as being especially risky.

The North Dakota Department of Health has found no deaths in the state but has documented 10 confirmed, 10 probable and two suspected cases of vaping-associated illness cases since it began surveillance last summer, said Kodi Pinks, epidemiologist.

Department epidemiologists review each reported case of lung injury to determine if it meets the criteria established by the CDC for vaping-associated cases, Pinks said. The review includes use of e-cigarettes, evidence of a chest CT (computerized tomography) scan, and absence of a pulmonary infection.

“We have seen a decrease in cases as time goes on,” Pinks said.

A bit of good news: “We have not had any new cases since December,” Pinks said.

Misconceptions

The use of electronic cigarettes is mistakenly viewed as a safe alternative to smoking tobacco products, because they contain less of the substances — such as the tar, chemicals and carcinogens that cigarettes have — that are known to damage the lungs and cause illness, Mangardish said.

Diagnosing a vaping-associated illness can be difficult because symptoms are similar to pneumonia, he said. When a patient presents with severe respiratory symptoms, the doctors’ first task is ruling out the more common illness, such as pneumonia, that people with these symptoms usually have.

Since the outbreak of cases last summer, there has been an increased interest in the medical community about “downstream” effects of using e-cigarettes or vaping products, Mangardich said.

“People who are vaping are at risk for respiratory disease, the kind of chronic lung disease that causes people to be asthmatics and have chronic bronchitis and emphysema — basically, the same things that lead to chronic obstructive lung disease,” he said.

And,there are some reports that, because of ingredients in the liquids in vaping pods, users could be at an increased risk of developing cancer, he said.

Increased use

North Dakota has been found to have one of the biggest rate increases in e-cigarette usage in the past two years, according to a company that analyzed CDC data. A study of the prevalence of e-cigarette users from 2016 to 2017 in each state was conducted by Quote Wizard of Seattle to determine which states saw the largest increase or decrease in vaping usage rates.

An increase is also confirmed by data collected by the North Dakota Department of Public Instruction through the 2019 Youth Risk Behavior Survey, which showed a marked increase in the use of electronic vapor products among students in high school and middle school.

Among high school students, the number of students who “ever used” an electronic vapor product rose from 42.1% in 2015 to 52.8% in 2019. By grade level, this data found 38.4% in ninth grade, 49.4% in 10th, 61.3% in 11th and 63.4% in 12th had tried electronic vaping.

The number of high school students who used the product at least one day during the 30 days before the survey rose from 22.3% in 2015 to 33.1% in 2019.

The number of high school students who currently used electronic vapor products frequently, on 20 or more days during the 30 days before the survey, increased from 2.3% in 2017 to 12.1 %in 2019.

Among middle school students, the percentage who reported ever using this type of product rose from 15.5 to 20.4 in the past four years. The percentage of students who currently used the product on at least one day during the 30 days before the survey increased from 4.7 in 2017 to 10.3 in 2019.

The percentage of middle school students who currently used the product frequently, on 20 or more days during the 30 days before the survey, more than doubled, from .5 in 2017 to 1.2 in 2019.

‘Self-inflicted’

Looking back, Schnack said that when his son was hospitalized and began to recover, his fear turned to anger. He was realizing that the boy's health troubles were “completely self-inflicted.”

“It’s completely unnecessary,” he said. “These kids think they are invincible because no one in their circle of friends has been affected.”

He recommended that parents watch their kids’ behavior, look for evidence of vaping, and apply punishment — such as loss of vehicle use — to deter or prevent the practice.

His son stopped vaping a few months ago and is back in school now, but will continue to be monitored and treated for this condition, Schnack said.

As for the long-term effects?

“The doctors don’t know,” he said.