Transcription:

Colin Ward (Host):  In the month we celebrate the annual Great American Smoke Out, vaping is in the news more than ever. Today on the Hero Podcast, we’ll explore the concerns and any benefits of electronic cigarette use. Good afternoon. I’m Colin Ward, Vice President of Population Health. And with me as always, is Lyle Sheldon. Lyle welcome.

Lyle Sheldon, FACHE (Guest):  Good afternoon.

Host:  So, Lyle, let’s start with a personal question if you don’t mind here. Were you ever a smoker yourself?

Lyle:  So, everybody has a story about smoking and my experience dated back to when I was ten years old and Danny Bergman and I went in his doghouse and both tried a cigarette.

Host:  How’d that work out for you?

Lyle:  That’s the last time I smoked a cigarette. So, I don’t think I finished one and I vowed I was never going to try it again. So, 52 years later, I’m still a nonsmoker.

Host:  And today, we’re going to be joined by Dr. Vanisha Amin and Dr. Zarana Patel from our hospitalist program as well as Dr. Russ Moy the Health Officer for Harford County and the Harford County Health Department. And we’re going to talk about lung issues now occurring in people that vape both here in Maryland and across the nation.

Lyle:  So, Colin, it would be interesting you may not know this but actually over 1600 cases of lung injury nationwide and more than 34 deaths as a result of what many suspect may be this onslaught of vaping.

Host:  Okay well we are going to dive into that for sure. And also, let’s start maybe with Upper Chesapeake here. So, Lyle, we’ve been a leader and you’ve really driven a lot of this change in the movement away from smoking and nicotine use. Tell us about two important steps that the University of Maryland Upper Chesapeake Health took a few years ago related to smoking.

Lyle:  Well it’s hard to believe when you look back 20 or 30 or 40 years that individuals actually smoked on nursing units and in hospitals. And in 2000, when we opened up the campus here at Upper Chesapeake Medical Center in Bel Air, we decided to make it a nonsmoking campus. And then in 2015, we actually took it a step further and took the policy that we were not going to hire smokers. So, it’s been over fours years that we’ve taken the position that we don’t hire smokers at University of Maryland Upper Chesapeake Health. And as far as I know, we are only one of two hospitals in the state of Maryland that has taken that position.

We don’t think it’s a controversial position as a healthcare provider, and when you look at our vision statement, of creating the healthiest community in Maryland; we think that by taking this position of not hiring smokers, it’s the right position to take.

Host:  So, given that change, was there any pushback or what kind of impact have you seen from that change?

Lyle:  Interestingly enough I certainly thought there was going to be an editorial cartoon in our local paper with a cigarette sticking out of every body part of mine that you could put a cigarette in, in gest, but did not receive really any pushback. What we have seen is that our health claims and our utilization for health benefits is actually decreased and stayed at a level that is very, very different than most other organizations including healthcare providers.

We’ve also worked with those team members that were smokers and offered them opportunities for smoking cessation and it’s interesting, it’s an affidavit system because we can’t test for smoking but the number of team members that actually get a reduction in their health insurance premium as nonsmokers continues to go up and those that are getting charged continues to go down on that honor system.

Host:  You would say that we’ve seen the impact that you were looking for then.

Lyle:  Absolutely.

Host:  Okay, so let’s then explore how electronic cigarette use intersects with traditional cigarettes and nicotine and so when we come back, we’re going to be joined by Dr. Vanisha Amin and Dr. Zarana Patel from our hospitalist program to get specific about vaping related lung injuries and understand more about the causes of these pulmonary problems. You’re listening to the University of Maryland Upper Chesapeake Health Hero Podcast.

Welcome back to the Hero Podcast. I’m Colin Ward. And joining me now are Dr. Vanisha Amin and Dr. Zarana Patel from the Upper Chesapeake Hospitalist Program. Thank you for joining us doctors. so, Dr. Amin, as we get started, help us understand how the recent vaping related cases differ from lung problems associated with traditional cigarette smoking.

Vanisha Amin, MD (Guest):  Well you know what Colin, to best answer this question it’s quite essential to kind of understand the mechanism of how vaping devices work. E-cigarettes essentially heat nicotine and other chemicals to create a water vapor which is then subsequently inhaled. So, per precedented research, we basically know that there’s tobacco products, regular tobacco products have over 7,000 chemicals and they are usually fairly toxic to the lungs. Nicotine is the primary chemical in E-cigarettes as well as regular cigarettes. And although nicotine is that primary chemical, the big thing we don’t know is the precise chemical composition that the rest of these E-cigarettes may have.

Host:  So, we don’t know what else is in these E-cigarettes.

Dr. Amin:  Yeah and that’s the big issue here. So, this is precisely what makes vaping related lung injury in one way very similar to but in many ways very different from traditional cigarette smoking. So, although both are a form of chemical injury to the lungs; the chronicity of vaping related E-cigarette use is different from traditional cigarette use.

Host:  I’m sorry. Tell me because I’m not that bright. Chronicity, that’s a word I haven’t heard before.

Dr. Amin:  Yeah, so basically, at what – like you know the timeframe that the illness presents. So, with vaping, it’s presenting more acutely. Like within months to years, right versus regular nicotine use or traditional tobacco use is taking more than years like at least maybe even decades. So, that’s why vaping related nicotine use seems to present what we would call medically sub acutely or acutely which means in a shorter frame of time meaning within months, weeks, of initiation versus regular cigarette use related lung injury presents in a more chronic fashion i.e., after smoking for an x amount of years and smoking cigarettes can lead to these chronic illnesses such as COPD, emphysema, lung cancer, what have you.

Host:  And so Dr. Patel, these are being classified as injuries and not illness. Why is that?

Zarana Patel, MD (Host):  So, to better understand this, let’s go over a couple of the definitions. The way in the medical community we define illness is that you include both chronic as well as acute illnesses. Chronic illnesses have been around for longer, the patients have been suffering with those diseases for longer, they are taking chronic medications for this. Hypertension, COPD are just a couple of examples. I think Dr. Amin covered that definition quite well. Now acute means it’s new. It’s happening right now. Which is what injury is relating to. It’s that it is a new injury or a – for the lack of a better word, a insult to the body that has occurred like a broken bone. Or a laceration. Things like that.

Host:  So, this is a traumatic event.

Dr. Patel:  Exactly. So, we’re looking at a traumatic event for the lung from vaping. You can see this with other chemical injuries such as chemical burns, toxic fume inhalation. We saw this quite a bit with agent orange, things like that. So, that’s the type of injuries that you are seeing right now. So, now that we’ve defined illnesses versus injury; I can say that even though we’re defining vaping lung injury what I don’t want people to mistake is that this is not going to turn into an illness. Enough time hasn’t gone by for us to say that this is not going to turn into a chronic issue.

Host:  So, these devices are so new, there just isn’t the history for being able to do the research on it.

Dr. Patel:  Exactly. We don’t know down the road the injury could also result in an illness the way it did with certain chemical inhalations during wartimes. You may see something very similar with vaping. We will find out as time goes on. We are all hoping as a medical community that this doesn’t happen, but there’s a good chance that it will.

Host:  Okay now the CDC, the Center for Disease Control says that about 70% of people that are presenting with these vaping associated lung injuries are male and that the median age is about 24 years old. So, why does this seem to impact young males?

Dr. Amin:  Well yeah, you are absolutely right Colin. The CDC’s median age for vaping yeah indeed is 24. But we also have to remember 79% of these patients fall between the ages of 18 and 34, that’s a striking number, 79%. Patient X that we saw in the hospital initially presented with nonspecific pneumonia like symptoms. Cough, congestion, GI issues. Initially, we worked this patient up for pneumonia, treated with antibiotics. Subsequently, patient came in and he did improve so the thought is was this because the patient just didn’t have his vaping device or was it because we treated the pneumonia? Well, the thought is it was likely vaping because he came back within a couple of months with the same course of symptoms. Vaping cessation was recommended at the time and he hasn’t returned. His symptoms improved.

With that said, patient X that we saw in the hospital not only presented with nonspecific symptoms, was male, was within the age bracket of 18 and 34 years and also utilized marijuana with his vaping device. He aligned with all the commonalities mentioned by the CDC. So, per the 2014 article that was launched by NIH; to answer your second question; why is it more prevalent in men. Well women had a lower prevalence of traditional cigarette smoking rather than men. I would say that the CDC data with male prevalence is completely in line with the data we traditionally have seen of other tobacco products.

There is no data to support brain development component at this time. Generally speaking, men just tend to use tobacco products at a higher rate as compared to their female counterparts. Such differences are multifactorial. There is limited data to support that it may be secondary to hormonal differences, cultural as well as even behavioral differences that men and women have. Overall, though, nicotine is a highly addictive product that activates the reward pathway in the brain more so in men versus women. Addiction overall to any product, is a concern to healthcare providers nationwide.

Host:  So, now you mentioned marijuana and I guess that is one of the questions about the role of marijuana and specifically the THC in these injuries. So, what is THC specifically and has the Centers for Disease Control been able to connect this in any way with these lung injury cases?

Dr. Patel:  So, first let’s define what THC stands for. THC is an abbreviation for tetrahydrocannabinol. Now this is the active agent in marijuana. This what gives you that high sensation. It’s the one that has the behavioral component attached to it. So, that’s THC. Now there have been many reported cases that CDC and FDA have linked to THC being used in vaping that has resulted in vaping lung injury. The numbers that have thrown out is from 71% to 85% being the top most. But at the end of the day, let’s not forget that all of these products still contain nicotine. We should not become complacent that oh if I don’t use THC, I’m not going to get vaping lung injury. That may not be true. We don’t know if there is a single compound that’s causing vaping lung injury.

If we can’t pinpoint that product, I would find it difficult to say okay if you avoid THC, you should be fine. That’s not the case at this point.

Host:  So, but is there anything physiologically different about the way that THC would be processed by the lungs in vaping as opposed to someone that’s smoking through a different mechanism of smoking marijuana?

Dr. Patel:  Not necessarily. Now could this be that because it’s made in the streets, the composition is very different than the one that is being sold in stores. Of course. But we still can’t say that.

Host:  That’s an interesting point. As with any kind of substance abuser you don’t necessarily know what is in the thing so if you are making your homemade version of a vape pen for THC; you may not be ingesting something with purity that’s not going to impact your lungs is the problem. Is that right?

Dr. Patel:  Exactly. And we saw the same thing with krokodil, we saw this with synthetic marijuana. Anytime someone makes something at home, and they are developing these diseases and things are just spiraling out of control, now we are seeing vaping lung injury with this. Would I say okay use the store bought ones? Absolutely not. But most certainly avoid the ones that you buy off the streets or have been concocted in a home.

Host:  Got you. Okay so now Dr. Amin, what if anything does the research tell us about the effectiveness of E-cigarettes on the reduction of traditional smoking? Have we traded one bad for another bad in this case?

Dr. Amin:  Well that’s a great question. And let’s not forget E-cigarettes and cigarettes they all contain nicotine. Nicotine alone carries many risk factors especially to teens and young adults. As per the Surgeon General, nicotine no matter what mode of delivery has negative impact on teens and young adults. Adverse outcomes of nicotine include but are not limited to impaired decision making capability, increased risk of addiction to other products, other chemicals. As Dr. Patel mentioned, mood disorders along with poor impulse control. So, although vaping nicotine products have been marketed by various companies as an aid to help quit smoking; E-cigarettes have not received FDA approval as a safe alternative. Furthermore, there’s no statistically significant research to support the effectiveness of E-cigarettes on the reduction of traditional smoking among youth.

So, vaping just basically gained this immense momentum and per the Surgeon General, in 2015, E-cigarette use basically skyrocketed by 900% in high school students. And 40% of these young E-cigarette users had never smoked regular tobacco products or even used any other form of tobacco before.

Host:  So, we’ve got a case of a tool that was built to help potentially help people stop traditional cigarette smoking that’s now being used as an entrée point into smoking potentially.

Dr. Amin:  Well that’s the big thing Colin. I mean it was marketed by the company producing it as being safe. The FDA never really approved it as being safe.

Host:  Okay so now given that, the benefits and the harm of vaping are uncertain, would you recommend anyone using these products at all?

Dr. Patel:  In short, absolutely not. Please. We beg of you as an entire medical community please do not use this stuff. Now we don’t know what substance is resulting in vaping lung injury. Could it be THC? There has been documentation thrown out that it could have been the vitamin E. It could be the nicotine or any one of the 7000 compounds that Dr. Amin mentioned. We just don’t have enough information. Research is ongoing. But that does not mean we have an answer as of yet.

Now because of all of that, I would say just avoid vaping E-cigarettes as well as cigarettes at this time. Keep in mind, there is no safe tobacco product whether it’s vaping or E-cigarettes which is what Dr. Amin stated as well. There is no safe modality of delivering nicotine at this time. That chemical in and of itself has effects on the human brain. Whether you are young, old, it doesn’t matter. Now, FDA has a list of approved medication that can help you stop smoking or using vaping. If you are still struggling with vaping, there are certain types of symptoms that you should look out for. Let me list a few of them for you so that way you understand how vague this is. Cough, shortness of breath, nausea, fevers, chills, chest pain, vomiting, abdominal pain or diarrhea.

Host:  I think I’ve had all of those in the last month.

Dr. Patel:  And you want to know what? That patient X had all of those symptoms.

Host:  So, it makes it hard for you then to figure out what is actually going wrong with that person.

Dr. Patel:  Exactly and you are doing multitude of tests before you figure out and consider that this is a vaping lung injury. You are not only looking at vaping lung injury, that is the diagnosis you come to when you’ve ruled out everything else. Keeping that in mind, you are looking at a prolonged hospital stay because of vaping lung injury, that we may come to that diagnosis after running a battery of tests. You may need to come back in if you develop fever again and you are going to go through that same process again. And so, that’s why both CDC and FDA have an excellent website for you, to help you stop smoking. What I would recommend is that patients reach out to their primary care doctors or visit one of these websites or you know what, do both. At this point, all we can say is stay safe and stay healthy.

Host:  And don’t vape at this point is your advice.

Dr. Patel:  Exactly.

Dr. Amin: Amen.

Host:  All right well thank you Dr. Amin and thank you Dr. Patel from the Upper Chesapeake Hospitalist Program. When we come back, we’ll be joined by Dr. Russ Moy, the Harford County Health Officer to learn more about the efforts to prevent vaping associated illness and injury across the state and her within Harford County. You’re listening to the University of Maryland Upper Chesapeake Health Hero Podcast.

Time now for an Epic update as we get closer to our implementation date of March 15^th and joining us now is Steve Proust, the Director of Clinical Informatics and Laurie Wilson, the Assistant Vice President of Patient Services. So, Steve, we’re getting closer now. What kind of update can you give us on the Epic System itself?

Steve Proust (Guest):  Yeah thanks Colin. We’re about 120 days out. At this point the build is essentially done. That would include all the nursing screens and order sets and care plans and education. Testing is well in progress. Everything is checking out well and ready for training. Operationally, our clinical directors and managers are now shifting their focus on what we are calling clinical operational readiness. And this is really looking at our current processes, our downtime procedures, our policies and procedures and making sure that we have them all adapted to the new system. So, there’s a team that meets every two weeks that is working on this operational readiness and will make sure that our team is prepared for Go Live.

Host:  So, we’ve got the build itself and we’ve got the workflow to support whatever we built in Epic all ready to go.

Steve:  We are getting there. Absolutely.

Host:  Welcome back to the Upper Chesapeake Hero Podcast. I’m your host Colin Ward. And we have heard now about the lung injuries beginning to become more commonplace with people using E-cigarettes and we’re now pleased to have Dr. Russ Moy join us to get a better understanding of how public health officials view the issue. Welcome Dr. Moy.

Russ Moy, MD (Guest):  Great being here.

Host:  So, Dr. Moy, the issue with vaping and as it relates to lung injuries, what do we know about the use of vaping in Harford County and specifically within high school kids?

Dr. Moy:  So, within Harford County, first we really have some recent national data. The National Youth Tobacco Survey 2018 data shows that 20.8% of high school students vape and that’s a 78% increase from the prior year.

Host:  That’s one in five kids are vaping now.

Dr. Moy:  That’s one in five in 2018 and now the year to date 2019 data just came out last month. And the preliminary data shows 27.5% of high school kids, so that’s one in four.

Host:  I’m doing well in my math but it’s going the wrong way.

Dr. Moy:  Absolutely. Unfortunately, the Maryland data is not yet quite ready for 2018 but looking at the 2016 Maryland data, is shows that Harford County had a 7% higher youth vaping rate than the state as a whole and a 27% higher youth vaping rate than the nation as a whole. So, it’s not that good here.

Host:  So, part of the challenge here is that according to the NIH, about two thirds of teenagers think that E-cigarettes only contain flavoring. They don’t believe there’s anything else harmful in there. What do we know is actually in these E-cigarettes?

Dr. Moy:  So, interestingly, until a brand of E-cigarette is FDA approved, the manufacturers actually don’t have to report the ingredients in their E-cigarettes.

Host:  So, wait a minute, so they can – an E-cigarette can be on the market and available for purchase and not be FDA approved?

Dr. Moy:  That’s correct. Now, the existing brands have until May of 2020 to submit their E-cigarettes to the FDA to be approved but they’ve got the next several months where nobody knows really what’s in those cigarettes. However, what the National Institute on Drug Abuse say is that E-cigarettes can contain nicotine, flavorings, then a bunch of toxic chemicals such as lead, chromium, cadmium and other carcinogens. So, it could be bad.

Host:  So, just not even knowing is reason enough but potentially not enough to make people stop and think before they purchase.

Dr. Moy:  That’s unfortunately true.

Host:  And so, in terms of state regulations can you buy a flavored vape pen now or are those flavorings being outlawed?

Dr. Moy:  So, the way it works is that the US FDA was given authority to regulate E-cigarettes and other vaping products back in 2016. But that process only required the FDA approve new vaping products. That’s why these existing products on the market like Juul, which has 70% of the E-cigarette market has until next year to become FDA approved. In this state, in Maryland, there’s no statewide vaping ban. Except for Mark commuter trains, all other indoor places including bars and restaurants that are subject to the Maryland Clean Indoor Air Act are exempt from state’s vaping regulations.

Host:  So, that means you can vape indoors. You can’t smoke a cigarette indoors, but you can vape.

Dr. Moy:  That’s right. That’s exactly right. Now there are some jurisdictions in Maryland, Howard County, Montgomery County, Prince George’s County that have passed some local vaping bans that might restrict it some but there is no statewide ban and nothing in Harford county.

Host:  Now there is a new statewide task force that the comptroller is launching. So, tell us a little bit about that task force and what it’s aims are.

Dr. Moy:  So, back in October, our comptroller Peter Franchot announced that he is creating a task force to look at the public health and safety implications of electronic smoking devices. So, this task force will be focused on at least three objectives. First just to better understand the nature and characteristics of E-cigarettes. Secondly to get a better picture of the public health and safety implications of E-cigarettes and the commercial effects of product sales in Maryland. And then finally, to make recommendations for stronger laws to ensure that consumers especially young people are protected.

Host:  And so that may be where if there were to be a state ban, it would come as a result of this task force?

Dr. Moy:  That’s correct.

Host:  Okay. I guess one of the big questions is are there enough scientific studies that talk about the impacts of vaping and whether there are benefits in terms of transitioning people or not?

Dr. Moy:  So, a couple of things. First about vaping cessation. So, the science on vaping cessation hasn’t yet caught up with this big increase in vaping so it’s not yet clear that the traditional smoking cessation methods are going to work with vaping. So, I should just know this, but folks still need help. So, the Maryland Department of Health has a couple of websites one is www.smokingstopshere.com which talks about the Maryland Tobacco Quit line which is 1-800-QUITNOW. And the second site is www.notobaccosalestominors.com and that gives more information about the Maryland Tobacco 21 law which just took effect in October making retail sales of tobacco products including E-cigarettes to people under the age of 21 illegal.

So, that’s about smoking and vaping cessation products. But I think where you asking more about this controversy about is vaping possibly helpful for some?

Host:  Yeah, so, I guess the question in my mind is at some point it appeared that the use of electronic cigarettes were actually providing benefit to long-time traditional cigarette smokers and helping wean them off. And then at some point, that benefit was replaced with a new danger which are these lung injuries that we’ve heard about.

Dr. Moy:  Right. So, this is pretty interesting. Because worldwide, there’s actually a controversy about is vaping – everybody says vaping they know is harmful but maybe it’s less harmful than smoking traditional cigarettes. So, in the United States, the general push is that vaping is just not good. But in other places like England, so they have a entity called Public Health England which is sort of like the CDC over in England. They are actually pushing hard that vaping is a harm reduction tool to help folks quit smoking. Here’s the difference. The difference is who is your target audience. If your target audience are nonsmokers, and that’s the target audience that the CDC has here; it’s never good to vape, it’s never good to smoke. But if your current audience are smokers; and in this country it’s about 15% of folks well then maybe for them, it might be helpful as a harm reduction tool but it’s not FDA approved as a smoking cessation or a vaping cessation device.

Host:  Okay so if I’m following you then, what it says is – what the Public Health thought here is if you are already smoking, vaping may be a beneficial way to help you wean off, maybe,

Dr. Moy:  Maybe but there’s no proven evidence on that.

Host:  Okay. But if you are a never smoker, jumping into vaping is bad.

Dr. Moy:  That’s absolutely right. And then the one last wrinkle is what’s happened over the last couple of months with regard to these lung injury cases. Until they can figure out what is the causative agent for those cases; what we’re saying and then we have a local health improvement coalition in Harford County and what we’ve issued a position statement and what we’re saying is until they figure out that causative agent, nobody should vape and of course nobody should smoke.

Host:  And so, I guess there are parents of teenagers that are trying to struggle with how to have the conversation with those kids now and other people. So, what is the advice to parents or school administrators or coaches?

Dr. Moy:  So the first thing I would suggest is for parents to not be confused about this back and forth debate about E-cigarettes potential use as a tobacco quit aide. For teens, they should never smoke. There should be no discussion about teens ever smoking. Partly because nicotine is very addictive so it can create a whole generation of young people who are going to be addicted but their brains are developing still. And it harms the brain development. So, teens should never smoke.

Host:  And so teens that start with vaping are more likely to move on to cigarette smoking.

Dr. Moy:  Right but even just vaping 98% of the vaping instruments even though the FDA has not yet regulated all of them, but they say 98% has nicotine. So, if you got nicotine in it, you really should not be vaping. You shouldn’t be vaping period if you are a teen. But the second thing we suggest is that parents should talk to kids about the risks of vaping. So, to do that, you got to figure out why kids vape in the first place. So, they vape because their friends do it, because the flavorings. The flavorings are enticing. And then they are also confused about vaping being safe. And it’s not. And that’s what parents should focus in on is talk with your kids about the risks of vaping. Finally, if parents need even more help, they should think about maybe going to the child’s doctor because the doctor can maybe talk more confidentially with the child and provide some expert input on the risks of vaping.

One other thought, so at Harford County we have our local health improvement coalition that’s chaired by Vickie Bands over at the hospital. We have issued this position statement on vaping. And we say that because the rapid rise in E-cigarettes has largely been the result of aggressive social media marketing aimed at kids, one of the interventions we are promoting is media literacy awareness as something we can possibly share through the schools. So, media literacy is a set of skills that can help change attitudes, teach people how media messages are designed to influence them and contribute to changing long term behavior. This type of counter marketing has been used with some success with anti-tobacco marketing in the past and we hope it will help with anti-vaping marketing in the future.

Host:  All right, Dr. Russ Moy, the Harford County Health Officer. Thank you very much for your time.

Dr. Moy:  I appreciate it. thank you.

Host:  Time now for an Epic update as we get closer to our implementation date of March 15^th. And joining us now is Laurie Wilson, the Assistant Vice President of Patient Services. So, as we get closer to March 15^th, Laurie what does our frontline team need to know about training to be ready to use Epic on the Go Live date?

Laurie Wilson (Guest):  Our nurse managers received the schedule for training about a week and a half ago and they are currently signing their team members up to train. Most registered nurses need about 16 hours of training. If they are cross trained in let’s say the inpatient area and the emergency room; they may need extra time in the classroom. I think the most important thing is once they are signed up for these classes, it’s practice, practice, practice so there’s something called hyperspace in Epic. It’s kind of a virtual

Host:  Sort of a sandbox kind of situation.

Laurie:  Yeah. it’s a practice module. So, the importance is that they get in there after their 16 hours of classes or 20 hours of classes and just practice as much as they can so when we Go Live on the 15^th, that they are ready.

Host:  And so again, they should look for their managers to sign them up for this training. Correct?

Laurie:  Yes, this is different. We have had a self-scheduling process in place for many years here but we’re trying to train about 1000 nurses and nursing techs within a six week timeframe. So, in order to assure that we’re able to staff our units and everyone is able to complete their education; we really need the managers to coordinate that.

Host:  So, we’re getting excited for the coming of Epic here to Upper Chesapeake on March 15^th. Laurie, thank you very much for the update.

Welcome back to the Hero Podcast. Joined again by Lyle Sheldon, the Upper Chesapeake Chief Executive Officer and Lyle November is lung cancer awareness month and the Great American Smoke Out is on November 21^st. And as you think about what we’ve done here at Upper Chesapeake related to tobacco use and cigarette use, how do you see our policies evolving into the future. You mentioned earlier that we are having fewer and fewer people smoke. What about vaping, what about other tobacco products?

Lyle:  As we’ve been on this journey for so many years, taking a position on smoking cessation, that will continue and as our policies evolve and as vaping and electronic or electric cigarettes have come into play, e-cigarettes, that also is included in our policy. And again, it comes back to our vision at University of Maryland Upper Chesapeake Health about creating the healthiest community in Maryland. And certainly one way we think we can do that is to continue to promote nonsmoking and have these policies in place that we think are appropriate and social policies as well.

Host:  Excellent. And so Lyle, we are heading into the holiday season here, so we would be remise if we didn’t mention this. This is a time when most people gather with friends and family and celebrate the holidays and a lot of times contemplate what you are grateful for. And so we want to give you a chance to tell us what are you grateful for aside from appearing on Harford County’s top number one podcast. What else are you grateful for?

Lyle:  I continue to be grateful for 32 years of service to the Harford County Community here at University of Maryland Upper Chesapeake Health and the fact that we get to provide service for over 300,000 patients a year. And that’s a wonderful opportunity for those of us in particular that live here in Harford County and about 75% of our team members are Harford County residents. So, I’m thankful that many of us are in the position of neighbors caring for neighbors.

Host:  Well thanks again for joining us as we learn more about lung injuries associated with vaping and thanks to our guests Dr. Vanisha Amin, and Dr. Zarana Patel from Upper Chesapeake as well as Dr. Russ Moy from the Harford County Health Department. Our next episode will be released in December. For Lyle Sheldon, I’m Colin Ward and we hope you will join us in becoming a healthcare hero.