Within days, Alexander Mitchell passed from a 20-year-old tourism enthusiast to being kept alive by two machines that let air in and out of his lungs and oxidize his blood outside his body.  "He went from sickness to the door of death literally in two days," remembered his father Daniel Mitchell as he struggled to grasp the unthinkable. "The doctor said he was dying. Honestly, I was preparing to plan my child's funeral. I cried and cried for this boy. "
Alexander Mitchell's doctors at a hospital in Payson, Utah, were confused when tests came back negative for bacterial pneumonia and many common ailments. One exam, however, raised something unusual – evidence of abnormal immune cells in his lungs – usually associated with the rare, potentially deadly pneumonia seen in older people who accidentally inhale droplets of oil-based laxatives like mineral oil.
The lull will help save Mitchell's life. The young man's lungs failed – he had acute respiratory distress syndrome, a life-threatening and often fatal lung injury. The doctor told the family that he suspected the condition was related to vaping after hearing about similar cases elsewhere. The man from Provo, Utah and his parents had mentioned that he used electronic cigarettes. But until then no one had connected the dots. Doctors had taken him to the University of Utah's Salt Lake City Hospital for 65 miles, so they could provide him with the most advanced life support to keep oxygen flow and allow his lungs to heal.
Mitchell's case is among the most serious doctors have seen amongst the lung disease associated with vaping, now investigated by state and federal health officials – at least 193 cases in 22 states, many involving teenagers and young adults. On Friday, Illinois health officials announced the first known death from a vaping-related lung disease in an adult. They declined to provide further details. In the meantime, public health agencies are reporting an increasing number of cases.
There are more questions than answers about lung diseases and their relationship with devices that have increased in popularity, despite the small study of their long-term effects. E-cigarettes have been introduced as a way to help smokers quit by satisfying their nicotine craving without burning themselves, but their use is already epidemic among teenagers and young adults.
Those who have become ill have cooked a variety of substances, including nicotine-based marijuana products, and make "home-cooked" cooks of varying lengths and places. Although the cases appear to be similar, staff at the Centers for Disease Control and Prevention are careful not to know if the diseases are related to the electronic cigarette devices themselves or to the specific ingredients or pollutants that are inhaled through them. It is not clear even if they have a common cause or whether they may be different diseases with similar symptoms.
The severity of certain illnesses in healthy young people who were previously healthy is impatient family members and even some physicians.
"To see patients who are sick is extremely disturbing," says Sean Callahan, a pulmonologist at the University of Utah.
Alexander Mitchell thought he had the flu when he woke up earlier this summer with severe nausea, chest pain and breathing problems, but he got worse so quickly that his parents, and then even the doctors, were amazed.
the most terrifying moment when doctors say their son's lung failure requires an additional aggressive life-support machine known as ECMO The machine pumps blood from the patient's body to an artificial lung that adds oxygen and removes carbon dioxide replacing the function of their own lungs. Then the machine sends the blood back to the patient.
"Two tubes came out of it, one was dark red and the other bright red," recalls Daniel Mitchell. "Doctors said one-third of his blood had come out of his system at any time."
If Alexander removed his tubes, they warned his parents, "he would be dead in 30 seconds and there was nothing we could do. . "
The doctors told the parents that he might need a lung transplant if he did not show improvement. But after about nine days, life support machines allowed his lungs to heal. He managed to get home on July 7th. Utah University doctors who saw Mitchell, in addition to four similar cases this summer, have their own theory of what could be causing the vaping-related illness.
They say one culprit may be the liquid, commonly known as lime juice, which is a component of all electronic cigarettes. The products vary greatly, but they all contain a heating element that produces an aerosol from a liquid that consumers inhale through a mouthpiece.
The impact in the cases may be the result of something recently added to the oils "to dilute or add to them," says Scott Aberg, a pulmonologist and critical care specialist at Utah University who cares for Mitchell and four patients in
Some of the patients had been vamping for months and years, he said, so if there were a previous bunch of cases, "we would have recognized him sooner."
however, in some cases it is difficult Some patients say they buy cartridges containing ingredients in other countries One patient told doctors he had his cartridges in Las Vegas and appeared to be open, probably introducing THC, the main ingredient that produces mind-altering effects THC is not legal in Utah.
Vaping fluid may contain nicotine, flavorings, propylene glycol, vegetable glycerin and other ingredients, according to the Food and Drug Administration, which regulates tobacco products, including electronic cigarettes.
When the liquid is heated, the resulting aerosol may contain fine and ultra-fine toxic particles, including heavy metals, chemicals used for flavoring, such as diacetyl, associated with a serious lung disease known as popcorn lung, and volatile organic compounds that can cause long-term health effects, including cancer, according to the 2016 American Surgeon General's Report
"We do not know whether it is propylene glycol or glycerol or other supplements in vaginal fluids placed there so producers or those things in combination with other adulterers, after production, when people add or mix, "said Abereg.
Some of the Utah patients had milder illnesses than Mitchell's. But four out of five also have abnormal immune cells in their lungs, Aberg said. Such cells are indicators of various diseases, including a rare condition known as lipoid pneumonia, whose symptoms include chest pain and difficulty breathing – similar to the symptoms of bacterial pneumonia.
Aberg warned that he remained very unknown about what causes abnormal immune cells in patients with vaping-related disease.
But "in many cases, we have a high level of confidence that what we are dealing with is not just an association, it's caused by vaping and what's been in the products," said Abereg. Abnormal cells can be a "very important marker for vaping-related pneumonia" and "an important key to what is happening."
Six weeks after leaving the hospital, Mitchell resumed tourism. But with his lung capacity reduced by 25 percent, he does not walk as long or as often as before. He also struggles with his short-term memory. Doctors say they are not sure if it will fully recover.
Doctors say that his youth was a decisive factor in his survival. "He was young, otherwise healthy and in good physical condition before the onset of the disease," says Aberg, one of about 20 clinicians treating the young man.
Mitchell says he remembers a little about what happened while he was in the hospital, since he was in a medically induced coma for much of the time. However, he is stunned that doctors attribute his experience to the death of vaping, a practice he started about two years ago because he wanted to give up conventional cigarettes.
"Promoted as healthier," he said.
Mostly he said he had used flavored nicotine products but had used THC several times with friends, he said. None of them got sick.
In mid-June, Mitchell says he buys a different brand of vape juice – peach menthol – from his regular vape shop and uses it with his same e-cigarette device. For the first time, he uses a well-known brand. The family doesn't want to identify him until the FDA investigates further. "It was a whole new box," Mitchell recalled. Inside, "the bottle had a seal."
He said he had missed less than usual during that time. The next day he became ill and began his life-changing medical odyssey.
Adults can make decisions for themselves, Mitchell said. But he said his experience should be a warning of dangers not clearly spelled out in the release.
"I didn't think it would literally lead to my death bed," he said.
Alice Critics contributed to this report.