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Doctors treating deadly vaping disease face a problem: Some patients lie



A man exhales money while using an electronic cigarette device in San Francisco.

David Paul Morris | Bloomberg | Getty Images

There are two people you should never lie to, says Dr. Michael Plisco of Patients, Your Lawyer, and Your Doctor.

A critical care pulmonologist at Mercy Hospital in St. Louis thinks a patient's lie can cost his life when he appears at the hospital after months of feeling unwell. By the time Plisko saw a man in his 40s, his lungs were so hard that they couldn't push any fluid out, putting him at risk of cardiac arrest.

Doctors have tried extracorporeal membrane oxygenation, a machine that pumps blood through a person's body while bypassing the lungs and heart. It didn't work. The man's organs failed and he eventually died in September.

The man whom Missouri state health officials declined to disclose further details about initially refused smoking or vaping, Plisko said. As he became ill, he finally admitted to vaping THC, the psychoactive ingredient in marijuana.

"In his mind, he did not injure himself," Plisko said, adding that if doctors knew earlier, they could tell the person to stop vaping, which Plisko said may have saved his life .

Patients who lie

Doctors trying to unravel the mysterious cause of vaping-related deadly lung disease that killed at least 42 people in a problem trying to find the cause: Some of their patients they were lying about what they fell for. This further complicates the already difficult investigation.

Named EVALI ̵

1; short for electronic cigarette or vaping related to the use of the product injury to the lungs – the disease has affected more than 2170 people, most of them young men. What began on several occasions in the spring has become a national public health crisis in the summer.

Doctors say the disease is deadly, sending almost everyone who develops it to the hospital and about half of intensive care. Although the pace of the disease has slowed, it is still wreaking havoc in the US, where doctors have identified an average of nearly 200 new cases a week since mid-September. A 17-year-old patient received a double lung transplant on October 15 after spending more than a month at three Detroit hospitals. Probably the culprit

USA. and public health officials have traced the disease to vaping, most notably THC, and have so far identified vitamin E oil as the likely culprit. There may be "a lot of problematic substances that cause damage to the lungs," CDC Chief Deputy Ann Ann Schuhat told Congress last week.

"There may be only two types of people who get this disease: those who are devastated by THC and those who will not admit it," said Dr. Scott Aberg, a critical care pulmonologist care at the University of Utah Health. Aberegg has treated more than 30 patients with EVALI so far.

The Food and Drug Administration, which launched a criminal investigation into the epidemic in the summer, began to seriously emphasize that it does not prosecute individuals who have even taken THC out if they live in countries where it is still illegal.

"Let me be clear, [the FDA] do not pursue personal use of controlled substances in these cases," Mitch Zeller, director of the FDA Products Tobacco Center, told reporters at a Sept. 19 conference.

Most people lie

However, many patients are initially reluctant to tell their doctors that they have fallen out of THC.

Most people actually lie to their doctors at some point, especially for potentially disturbing information such as how much they drink alcohol, their eating habits, and exercise.

Two studies published in the Journal of the American Medical Association last year found that 60% to 80% of the 4510 adults surveyed refused key information from their physician . The most common reasons for withholding these details include that they do not want to be judged or lectured, they do not want to hear how harmful their behavior and embarrassment is.

This explains why someone may not want to tell their doctor that they are vaping THC, even though marijuana's social uptake is at the highest level. Two-thirds of Americans say they support legalizing it, according to a 2018 Gallup poll. Thirty-three states and Washington, D.C., have legalized medical use, and 11 states and DC have legalized recreational use under the Marijuana Policy Project.

Negative stigma

But marijuana is still illegal at the federal level and is far from a mainstream change. Some EVALI patients, even those in critical care, refuse to use it until drug tests show THC in their system, doctors say.

The Centers for Disease Control and Prevention released data on what patients were vaping for 867 of EVALI cases by October 15. Of these cases, about 86% reported using THC, the psychoactive substance in marijuana. Many said they used both THC and nicotine. Yet 11% said they used exclusively nicotine. Some doctors think it's possible 11% who say they used only nicotine may be lying.

"Each individual patient may have reasons why he does not want it. It is known that it vapes and specifically what it vapes, "said Dr. Ram Kopaka, a medical officer at the National Center for Immunization and Respiratory Diseases of the CDC, which works on the outbreak response.

Key information

It is difficult to determine how many patients refuse information from doctors or how many cases are not counted because one will not admit to vaping – key information needed to diagnose EVALI, Koppaka said.

With the advent of headlines in America, doctors say patients are more likely weeks ahead of what they vape. People who disappear and experience symptoms now worry that they may have the disease, doctors say.

EVALI looks and sounds like pneumonia. Symptoms include chest pain, shortness of breath, fever, nausea and vomiting. But this is not an infection. The antibiotics used to clear pneumonia do not help the vaping disease. And without knowing that the person is boiling, doctors can continue the wrong treatment or miss the opportunity to encourage the person to stop.

"Clinicians need to know that there may be this reluctance and make sure that because they are evaluating patients and asking about their habits, they should do it in a very irrelevant but thorough way," Kopachka said.

] Drug Testing

Abereg treated a man in his 20s for EVALI who repeatedly refused to validate THC until a drug test came back positive. , Aberg told the patient how doctors are increasingly treating people for pain

At that moment, tears were pouring into the patient's eyes. He asked his parents to leave the room, Aberg recalled. The young man said he was vaping THC for treatment

Dr. Melody Pirzada, who treated nearly 20 patients for EVALI as Chief of Pediatric Pulmonology at Winthrop Hospital in New York , said that doctors should be sure about what patients took out – especially those who they say it was just nicotine.

"Well, if they're actually hiding, they did THC? That's the problem I have," she said.

Unrated Questions

CDC Encourages Doctors to Ask Patients if They Vip and Do What They Do? "re-breathing – and even asking patients if they can be tested for drug use. The agency recommends that doctors hire" compassionate, inappropriate "and" private questioning of patients about sensitive information to ensure confidentiality. "

"In some situations, asking questions during hospitalization or follow-up visits may lead to additional information about exposures, especially after trust has been established between patients and clinicians," CDC staff wrote in

Whatever people use, doctors say they should have open conversations with their doctors about this deadly disease. [19659002] "It's so important to tell your doctor," Plisko said. "Most diagnoses very few diagnoses are made in laboratory tests. "


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