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Robin Kish (Host):  Take a deep breath as we dive into a popular and potentially harmful trend, E-cigarettes. How do they affect the lungs? Our youth and those trying to quit smoking, what you should know about vaping on this edition of Here for Your Health.

Welcome to the Healthcare District of Palm Beach County’s podcast Here for Your Health. I’m your host, Robin Kish. The Healthcare District is a unique healthcare system located in Palm Beach County Florida. Did you know that Healthcare District provides county residents access to primary care, skilled nursing and hospital care or that the Healthcare District staffs registered nurses in nearly all of our public schools. Or that we fly, maintain and operate the county’s two life saving trauma hawk air ambulances. Through all of these programs, the Healthcare District serves as healthcare safety net for Palm Beach County. On this edition of Here for Your Health, we take a closer look at the trend of vaping and the latest findings on the harmful health effects E-cigarettes can cause. Our guest today is Dr. Barry Davis, General Surgeon at Lakeside Medical Center, the Healthcare District’s rural acute care teaching hospital in Belle Glade Florida. Welcome Dr. Davis.

Barry Davis, MD (Guest):  Great to be here, thank you.

Host:  Doctor, E-cigarettes have been touted as a safe way to quit smoking. Is that true?

Dr. Davis:  It is a myth. A number of people have tried to quit smoking but it’s very difficult and there’s so many people that are attempting to quit daily. Nearly seven out of 10 smokers say they want to stop, and quitting smoking is the best thing you can do for your health. Smoking itself harms nearly every organ in your body including your heart. Nearly one third of all deaths from heart disease are the result of smoking and secondhand smoke. So, E-cigarettes have been marketed as an aid to help you quit smoking. They work by heating the nicotine extracted from tobacco along with other flavorings and chemicals to create an aerosol you inhale. Regular tobacco cigarettes contain several thousand chemicals, many of which are toxic. However, we don’t know exactly what the chemicals are in E-cigarettes.

Host:  Well it’s thought that E-cigarettes have fewer chemicals than traditional tobacco cigarettes. Does that make them safer?

Dr. Davis:  Even though it may contain fewer chemicals, the FDA has not approved it for a smoking cessation tool. Many studies recently have found that people who intend to use E-cigarettes to quit smoking actually continued smoking regular cigarettes and E-cigarettes simultaneously. What’s more troubling is a number of studies that came out with these outbreaks of lung injuries and deaths associated with vaping. In January 21^st, early this year, the CDC confirmed that 60 deaths in patients with E-cigarettes or vaping, the product used associated with lung injury noted as EVALI or what is actually spelled out as E-Cigarette and Vaping Associated Lung Injury. These cases appear mostly to affect people who modify their vaping devices or use black market modified e-liquids which is the liquid that goes inside of the vaping device. And they are especially true for the ones that had the chemical THC. Many of the times they found that vitamin E acetate was what was used to cut the THC oil when they created the E-vaping liquid and that itself is what found to be the major problem. And so since then, they’ve tried to regulate it and it was just simple economics. They found if they cut it with the vitamin E acetate, it actually increases their profit while still giving people the same simultaneous high.

Host:  You mentioned the CDC or the Centers for Disease Control and Prevention. What does the CDC recommend?

Dr. Davis:  That you don’t use THC containing E-cigarettes or vaping products. And avoid using informal sources such as friends or family or online dealers to obtain your vaping device. And do not modify any of the substances or the vaping device as they are not intended by the manufacturer. In light of the EVALI, which is the lung injury syndrome that we were discussing earlier; the CDC advises adults who use E-cigarettes for smoking cessation to weigh the risks and benefits consider the use of an FDA approved smoking cessation options that we see commonly on TV over E-cigarettes.

Host:  Earlier this year, parents and students gathered at Jupiter Community High School locally for a seminar on the dangers of vaping. A panel of school district administrators, police, and physicians told the crowd that like most schools across the United States, Palm Beach County has seen a rise in vaping and that students are finding it tough to quit.

Dr. Davis:  This is a real problem. Young people in this current generation, they see the stigma associated with cigarette smoking and mostly with the smell of cigarettes after they smoke. So, they automatically gravitate towards E-cigarettes and then also you add to all the flavorings that come with it. the problem is, is they still contain nicotine so these children can still get addicted. And so, it makes an attraction to them one because of all their flavors but it still pulls in the direction of a nicotine addiction. And it’s just really troubling because they are not only the teens that would be more prone to smoking, they’re actually enticing a number of teens who would have never really entertained smoking at all and some of them as young as 12 that have started vaping. And using nicotine as a young adult or just a teenager is not good for the developing brain. And so the teens who vape are more likely to begin smoking cigarettes or use more harmful drugs down the road.

Host:  Can you explain clinically or physiologically how one becomes addicted to vaping?

Dr. Davis:  The main addictive property of cigarettes is the actual nicotine. And that itself will cause a almost a slight euphoria although it’s not the same high commonly found in many narcotics and other street drugs but it still does produce a reaction in the brain center for reward. And so by stimulating that, the more that they do it, and they continue to vape, their body actually becomes more dependent on it and without even knowing it, these young people begin to have actual cravings for vaping or even cigarettes if they are unable to get them.

Host:  Florida senate bill 810 has been waiting the governor’s signature this year, the legislation would largely bring this state into compliance with federal laws about electronic cigarettes and the measure would identify E-cigarettes and vaping products as “tobacco products” and raise the age to purchase any tobacco products including tobacco cigarettes, dip and chew as well as E-cigarettes from 18 to 21. What are your thoughts from a medical perspective?

Dr. Davis:  Anything that can curb teen vaping in Florida or even across the country for that matter, by limiting their access through age verification, raising the age limit to 21 and even banning certain flavors that may attract kids would always be beneficial and if we can save youngsters from the nicotine addiction alone and the associated risks I think that’s always going to be a healthy approach and should be encouraged.

Host:  Dr. Davis with so much public health attention now focused on the novel Coronavirus, what is the evidence around the relationship between COVID-19 and vaping?

Dr. Davis:  There is no scientific data yet to show that there are any differences in outcomes between people who vape versus those who don’t. However, according to the US FDA, vaping may create underlying health issues for people who use Juul and other E-cigarettes that make them more likely to suffer severe complications of COVID-19.

Host:  Do you know if there’s research on smoking and how that relates to COVID-19?

Dr. Davis:  Absolutely. That was one of the major things that was studied early on in this pandemic and they showed that the vaping actually inflames and damages the lungs. And so we also know that COVID can attack the lungs which is its main point of entry and what they don’t – they’ve learned that nicotine increases the number of ACE-2 receptors which are a part of the processing of oxygen in the lungs that act as what they call entry portals for the Coronavirus. And so according to research, increase in the number of receptors could potentially enhance COVID-19’s person to person spread although the study did not evaluate vaping separately from smoking, early data indicates that substance users are at higher risk for COVID-19. For example, some of the studies out of China on COVID-19 found that smokers in general are at more risk for severe disease. So, there’s a clear reason for those who are vaping or smoking to be very cautious.

Host:  How has social distancing impacted vaping especially among the younger generation?

Dr. Davis:  Well it’s had positive and negative effects. The physician who directs the adolescent substance use and addiction program at Boston Children’s Hospital has shared that the stay at home orders have helped some of her patients successfully quit vaping because they are no longer around friends who use it. But for other patients, the isolation has increased their anxiety and caused them to vape more. Some kids are still sharing vapes with other friends which is obviously dangerous. And then you have other teens that have quit whether they wanted to or not. And many are suffering withdrawal symptoms. www.Teen.smokefree.gov is a helpful resource for with tools and tips to help youngsters quit vaping and smoking. So, those who want to quit, can also call 1-800-QUITNOW. Quitting smoking is one of the best things that you can do for your health. Smoking harms nearly every organ in your body including your heart. And again, it really has a major role in heart disease later on in your life. So, it’s no point in starting early.

Host:  And I’m sure you give this advice to your patients as a surgeon and you have so many great health tips that you can share. So, before we wrap up, your focus on maintaining healthy habits and prevention to keep our community healthy must give you like a top five list of health prevention tips that you can offer us?

Dr. Davis:  Well just from today’s topic alone, being a former smoker myself, it was a game changer the time that I finally just made up my mind to quit. And this is someone – I studied in the UK for three years and people smoked absolutely everywhere. There was every restaurant, every bar, every outing, it didn’t matter. People smoked indoors and outdoors so it was very difficult, and I wasn’t actually a big smoker before I went. And so, quitting was very difficult but I just one day I knew it was coming and I finally just made up my mind and ever since then it’s been just change everything not just from your breathing but your overall health. But other things that play into that is I get a lot of questions about diet; I feel like the world media makes dieting such a difficult thing. If people just realize you just keep it very simple. Our rule in our house is we just don’t eat out of a box. And so, actually cooking your food, and mixing – make sure your dishes are very bright colored is a very simplest way to have a healthy diet. So, that means you have a very simple meat if you are a meat eater and if you’re a vegetarian, just having bright colorful vegetables and just not having so many fried foods in your diet is extremely necessary. And I’m again speaking from experience.

I’m getting older and I found out that my cholesterol was high several weeks ago from my primary care physician. And immediately I have – I stopped eating red meat. And I’ve eaten more chicken and fish and people just don’t realize we make it way more complicated, but the thing is, you also – we make excuses for ourselves. So, if you know what you need to do, it always plays like people don’t know. I think most Americans know what’s really healthy for them. And if they just really just take ownership of their own health, and actually have an active role in your health, will be the biggest thing that you can do for your self and actually for your family because I see it all the time when people get sick and they wish they hadn’t done it. I see diabetic patients all the time who don’t take care of their diabetes because they haven’t owned it since they were diagnosed years ago. And they meet me and they’re having major operations and some that are debilitating for the rest of their life and they wished that they had taken control of the disease early on like their physician was telling them.

Host:  You mentioned how hard it is to quit smoking, to change your habits. How did you do it?

Dr. Davis:  Well I’ve talked to so many of my patients about it and it’s funny, it’s not the actual smoking. Most smokers actually don’t like smoking. It’s the routine. And they know that when they get up in the morning time, they’ll have a cigarette and then they’ll go to – they’ll smoke on the way to work or they take their break at work and all these – their whole day they don’t realize is actually built around smoking. And it was actually the way that I did it is, I was getting ready to go on a vacation and I knew my routine was going to be disrupted and so I made up my mind that I wasn’t going to take any cigarettes with me on vacation. And it was just that simple. And so I was on vacation for nearly a week and I just – I just determined that I was not going to go and buy any and after like the first three days, I didn’t even care. And it was just the change in the routine. So when I got back home, I was already out of that routine of smoking so it wasn’t difficult and then when someone would smoke around me, it was – it would be so apparent to me because my sense of smell was back and I just – ever since then, I haven’t looked back and I’ve just been very grateful that I just decided to change my mind.

Host:  Did it help with your breathing, your ability to exercise?

Dr. Davis:  Oh absolutely. I train all the time. I’ve been in the military a long time and a lot of people smoked in the military. And we still have to train and all these things and it just – I always did well but I never realized how well I could do after I stopped smoking and ever since then, it’s – I don’t have to do all this work ahead of time for my PT test and all these things that I do. It’s because I don’t have problems. My wife and I can go cycling and we can go cycle ten to twelve miles and I will never get winded. But it’s not even that, it’s just your energy throughout your day. You just don’t realize how much it really take you because when your lungs aren’t healthy, your heart isn’t either. And so just going up a flight of stairs doesn’t – it will wear you out when you smoke.

Host:  Well Dr. Davis, thanks so much for joining us, providing your personal story and giving us all of the expertise that we can maybe learn from.

Dr. Davis:  Absolutely.

Host:  Well great advice. And we thank all of our listeners. If you find this podcast helpful, share it on your social channel and check out our full podcast library for topics of interest to you at www.HealthcareDistrictpodcast.org. Let us know what you think. Your review helps us reach more people just like you. And if you have a suggestion about a future podcast topic, have questions or some feedback, call 561-804-4111. Today’s podcast is brought to you by the Healthcare District of Palm Beach County’s Acute Care Teaching Hospital, Lakeside Medical Center in Belle Glade, Florida. For more information call 561-996-6571 or visit www.lakesidemedical.org. This podcast is also brought to you by the C. O. Brumback Primary Care Clinics which offer medication assisted treatment for patients with substance use disorders as well as primary care, dental services, behavioral health and pharmacy services for adults and children. Call 561-642-1000 to make an appointment or visit www.brumbackclinics.org.