“You performed the operation on a 17-year-old teenager who needed a transplant of both lungs.” Is it true that the irreparable consequences for his health were caused by vaping?

- Yes. The teenager was transferred to us from another hospital. The situation with his lungs worsened so much that it was already impossible to cure him with the usual, standard methods - antibiotics or ventilation. The condition worsened day by day. Then they contacted us to find out if we can transport this teenager to our hospital, examine him and decide whether transplantation is needed here.

- Some media called his condition mysterious. What diagnosis did you make? What did you find with him?

- Mysterious, that is, completely incomprehensible, it was not. By December 10, the United States recorded about 2,400 cases of severe lung damage in patients using vaping products. The condition of most of these patients was improved with conservative treatment methods. But in some, lung damage progressed, and in about 57 cases the outcome was fatal. One of these patients who received irreversible lung damage was this teenager.

“But at the same time, vaping and e-smoking are generally touted as a safer alternative to traditional tobacco products, as well as a way to quit smoking.” Do you agree with that? After all, the statistics you have provided indicate that these supposedly less dangerous alternatives can cause dire consequences.

- No, I do not agree that this is a safe alternative, which is suitable as a means to stop smoking regular cigarettes. The fact is that nicotine addiction also develops with vaping. So, as a doctor, I think this is a completely obscure concept. Such advertising is misleading, and the goal here, in my opinion, is to make a profit, not to care about the health of the population. As we learned during the recent epidemic, vaping and smoking electronic cigarettes are fraught with extremely dire consequences.

- You called vaping an epidemic. Is it really associated with many cases of disease?

- We are talking about an epidemic, because in the United States in March-April 2019, a number of cases of lung damage were detected in patients using vaping products. It is a serious illness that led to hospitalization or death.

But often people didn’t go to hospitals at all. So officially, we probably know only a small percentage. We only recently became aware that such a problem exists, and we say “epidemic,” because now new cases of lung damage are reported throughout the United States.

- That sounds really scary. In your long-term medical practice, was this the first patient to become ill due to vaping?

- Yes, he became the first. I am a surgeon and am involved in lung transplantation. Patients coming to my hospital for treatment are usually followed up by other doctors. If a person is recovering with the usual therapy by a pulmonologist, then he will not be sent to me. The same patient came here only because of the extreme severity of his condition. The specialists who treated him came to the conclusion that the only possible solution here is transplantation.

- Do you think that electronic cigarettes do more harm than regular tobacco?

- For me it is like different types of poisonous snakes. If a person dies from their bite, then I don’t know which is worse - a mamba, say, or a cobra. Both electronic cigarettes and regular cigarettes are harmful to health.

- That is, both are harmful and addictive.

- That's right. They are addictive and affect health. If we talk about cigarettes, it is known that over time, due to smoking, cancer, emphysema and other diseases can develop. People hoped that in the case of vaping, there would be no such harmful consequences. But we clearly observe its extremely negative effect on the body - and often over a shorter period of time.

  • Prior to his passion for vaping, the patient was a healthy and athletic teenager.
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  • © Bumble Bee / 500px

“Back to this 17-year-old boy you saved.” According to his relatives, he was an athlete, that is, physically strong. How do you understand that his pulmonary disease is associated with vaping? You say that you were not the first doctor to undertake his treatment. How did you manage to establish the reason and understand that vaping is to blame?

- In his medical history there was evidence that he used vaping products. According to some sources, over several months, according to others - more than a year. And this was somewhat confusing. Symptoms at that time were the suddenness of the disease, low-grade fever, cough, sore throat and chest pain and severe shortness of breath. This is very typical of the epidemic, which we spoke about a little earlier. Similar symptoms were observed in most patients who became its victims.

- Tell us how you prepared for such an operation as a double lung transplant. Still, the task was not easy.

- The preparation really was an extremely difficult process. The first step was to understand whether the patient is a suitable candidate for transplantation from a socio-psychological and economic point of view. It was also necessary to evaluate the general state of his health, to make sure that he had no other serious problems.

As for the preparation for the operation itself, we included it in the list of patients awaiting transplantation and began to wait for a donor organ to be offered to us. We have a whole team here - we carry out transplant operations regularly. So the process itself has been established.

First, a proposal arrives, then we analyze it: evaluate the donor, study the characteristics of the organ, its size, find out the blood group. If everything seems to be compatible, then part of my team is sent to a donor clinic to directly get acquainted with the proposed body. In the event that they are satisfied with everything, a decision is made about the operation in our clinic. That part of the team delivers donor lungs, and we transplant them.

- And how did you personally prepare for the operation?

- First they called me and said that there is a good offer. I spoke in advance with the patient's family. He was in an extremely grave condition, unconscious. He lay under anesthesia, in a medical dream so that nothing would bother him. We talked with the family, clarified all the pros and cons and got consent. After this, an operation was prescribed and they began to wait for a report from our employees who analyze the donor lungs in order to understand whether they are suitable for the patient. The lungs came up and we started the operation - me and my colleague, another surgeon. And now - she held.

- Tell me, is there any significant difference between the appearance of the lungs, destroyed by vaping, and the lungs affected by normal smoking?

- They look completely different. In the lungs affected by normal smoking, a disease called emphysema usually develops: they pathologically increase, the interalveolar septa collapse, large cavities filled with air appear, and the so-called bullous disease develops.

Lungs damaged by vaping, in particular those that I was dealing with, contained a lot of fibrous, scar tissue. The normal, natural texture of the lung tissue has completely disappeared.

The tissue of the walls of the alveoli, vesicles in which gas exchange occurs, has been replaced by scar tissue. Everything was light in scars, it became very heavy, dense and extremely stiff. It was more like a liver than a lung.

  • Dr. Hassan Nemeh: “The normal, natural texture of the lung tissue has completely disappeared”
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  • © Henry Ford Health System

- Well, well! Did you expect to see this?

- On the basis of x-rays - yes. And although the X-ray prepared me for this, to be honest, I was surprised at how bad the lung was both in appearance and to the touch.

And the reason was vaping?”

- Yes, the reason was vaping. Of course, we do not know which substance is responsible for this epidemic. A number of possible options are voiced, and scientific studies give us evidence (or at least reason for suspicion) that sometimes vitamin E acetate is added to the vaping fluid, and this is the likely cause of most of these cases. But there is no absolute certainty that this is the only substance that causes this problem.

- You said that you did not have the opportunity to properly talk with the patient, because he was in a state of medical sleep. And what did he say after the operation, when it became clear to everyone that it was successful?

- At first, of course, he was very happy. Yes, he was in a medical dream, but he still knew that he had a very serious condition and that he could die. However, when the young man woke up and realized that he had a transplant and now he would have to take medications and so on, for some time he was very upset. Then, of course, he realized that he had received a second chance at life, and was very happy and grateful for that. The last time I talked with him, he said that he was going to become an activist in order to try to convey to people what health effects fraught with vaping.

  • Doctors confirm that vaping is fraught with deadly health consequences
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  • © Dontstop

- A noble cause. And how many years can you live after a lung transplant? Are there any general statistics on this?

- Yes. Speaking generally for all age groups, the forecast is as follows: somewhere around 50% of those who underwent transplant surgery live another seven to eight years. In general, younger patients after lung transplants tend to live longer. About 25-30% manage to live ten years. Thus, life expectancy after a lung transplant is not very long. But if we consider that without it, our patient would have no chance at all, then it is obvious that this is a good option.

- Are all your patients smokers?

- No, we have different groups of patients. Some of them are former smokers. They abandoned this habit, but already managed to get pulmonary injuries, which progressed even without smoking. Others come to us with a diagnosis of pulmonary fibrosis, the cause of which is sometimes unknown, and it's not about smoking. There are also cases of pulmonary hypertension, where it is also not about smoking. And besides, such genetic diseases as cystic fibrosis, as well as diseases of an infectious nature that are not necessarily associated with smoking. In general, I would say that lung injuries caused by smoking are observed in about a third of our patients.

But the lungs of a person are vulnerable to many other factors besides smoking.”

- That's right. Man, like any other living organism, is susceptible to a number of diseases. Quitting smoking, of course, will benefit your health, but insurance is not all bad.

- Tell me, what would you forbid if you had such an opportunity: smoking or vaping?

“To be honest, both.” Since both are extremely harmful. And vaping was also promoted as something that even children can do. And this worries me most of all, because the children are extremely vulnerable, and it is unacceptable to act on them in this way. To develop their nicotine addiction - doom the future generation to disaster. So, I repeat, this bothers me the most.

See the full version of the interview on the RTD website.