White Coat, Black Art

'It was terrifying': Teen who collapsed after vaping nicotine is now warning her peers

High schooler Erin Dexter collapsed and ended up in the hospital after a morning vape in November. Health Canada is tracking cases of vaping-related severe pulmonary disease, but not lower-level incidents like blackouts or seizures that may be the result of absorbing large amounts of nicotine.

Vaping-related severe lung illnesses tracked, but not lower-level incidents, including nicotine poisoning

Erin Dexter, right, collapsed in November shortly after vaping. 'It was probably the most terrifying event I've ever gone through,' said her mother Laura Dexter, left. (Mary-Catherine McIntosh/CBC)
Listen to the full episode26:28

Like many of her peers, high schooler Erin Dexter would regularly slip into the school bathroom between classes to vape.

But that stopped after she collapsed and ended up in the hospital after a morning vape in November.

"It was terrifying. Probably the worst moment of my life," she told White Coat, Black Art host Dr. Brian Goldman.

Now she's sworn off it, and is urging her fellow students to do the same.

Health Canada has so far documented 11 confirmed or probable cases of vaping-related severe pulmonary disease, but it's not currently tracking lower-level incidents like blackouts or seizures, which one toxicologist says are common side effects of absorbing large volumes of nicotine.

And experts are warning that governments aren't moving fast enough to push back against the explosion of popularity of vaping among teens, who may be especially susceptible to nicotine-related illness and addiction.

'There was blood everywhere'

Dexter, 16, was at her father's house in Elmsdale, N.S., on Nov. 10, when she took a hit from her vape device shortly after breakfast. Soon after, she started to feel dizzy.

She woke up on the floor about three minutes later with a busted lip, a chipped tooth and a broken nose.

Erin Dexter examines her lip, which was injured in her collapse. She received stitches in the hospital after her fall. (Mary-Catherine McIntosh/CBC)

"There was blood everywhere," said Dexter's mother Laura Dexter, who called her daughter a healthy athlete with "no health issues whatsoever" before the incident.

"She was crying; we were all crying. Her father was in a state — hysterical, actually. He just kept saying [to me,] 'Laura, I thought she was gone.'"

Dexter received stitches for her fall at a local emergency department. 

Tracking vaping-related emergencies

It's difficult to determine how many teens or adults have suffered similar fainting spells or seizures as a result of vaping.

Dr. Martin Laliberté, an emergency physician and toxicologist at McGill University Health Centre, said Dexter could have suffered either a seizure or a fainting spell caused by a sharp drop in blood pressure.

Dr. Martin Laliberte is an emergency physician and toxicologist at McGill University Health Centre. (Submitted by Martin Laliberte)
Both, he says, are well-documented possible side effects of quickly absorbing lots of nicotine.

Laliberté suggested the number of people who might suffer a vaping-related blackout or seizure is probably small compared to the total number of people vaping today.

"But that's concerning, because we're talking about a recreational activity done by teenagers," he said.

According to Remo Zaccagna, a representative from Nova Scotia's Emergency Health Services, Dexter's "circumstances as described would not be a reportable case" along Health Canada's current reporting guidelines.

"EHS Operations does not capture data on vaping-related calls," and so were unable to comment "on whether such calls are increasing in frequency."

A CMAJ report found that e-cigarette-related calls to B.C.'s provincial poison centres increased sixfold between 2012 and 2017, but most of those cases involved accidental ingestion, such as mistaking vape liquid for another substance like eye drops.

Vaping products have been promoted as tobacco smoking cessation products, but also as a trendy hobby. Some health experts are advocating for governments to curb advertising for vaping that may be seen as targeting youths. (Adnan Abidi/Reuters)

The 'head rush'

Prior to her collapse, Dexter had been vaping for about eight months. She described getting a "head rush" with fruit-flavoured vapes with small amounts of nicotine at first, but eventually graduated to liquid with a higher concentration — 50 milligrams per millilitre, or five per cent nicotine — to reach the same heights.

In total, she'd vape liquid at 50 mg/ml strength five to 10 times a day — roughly the same amount of nicotine in two and a half packs of cigarettes. Each vaping pod, or charge, contains enough liquid for a couple of sessions.

Dr. Hassan Nemeh of Henry Ford Hospital in Detroit performed what is believed to be the first double-lung transplant of a patient whose lungs were damaged by vaping. (Henry Ford Health System)
Teenagers may be more susceptible to nicotine addiction because their brains haven't reached a stage of development that most adults have, explained Laliberté.

"That [addiction] may be not as spectacular as a lung disease [case], with the cannabis-containing cartridges, but that's actually fairly worrisome," he said.

Dr. Hassan Nemeh, surgical director of thoracic organ transplant at Henry Ford Hospital in Detroit, sees parallels in vaping companies' marketing with the way tobacco companies marketed cigarettes in decades past.

"They used to be marketed as, they're good for you. They're prolonging your life because they calm down your nerves and make you able to cope with stress," he said.

"So I'm seeing a similar analogy here, albeit to me it looks a little more dangerous."

Nemeh has seen the worst of those dangers up close. In September, he performed what may be the first double-lung transplant on a person whose lungs had been severely damaged by vaping. The patient was 17 years old.

Vaping products are currently banned for sale to minors in Canada, but that didn't prove to be an obstacle for Dexter, whose friend's grandfather would buy vapes for them on a regular basis.

Provincial efforts to regulate vaping include raising the minimum age required to buy vapes, banning advertising in public spaces frequented by youths, and banning fruit flavoured varieties.

On Friday, Nova Scotia Health Minister Randy Delorey announced plans to deliver new vaping regulations next week, according to the Canadian Press.  

Juul products are displayed at a smoke shop in New York on Dec. 20, 2018. On Oct. 17, 2019, the company announced it will voluntarily stop selling its fruit and dessert-flavored vaping pods. (Seth Wenig/Associated Press)

Laliberté is encouraged by these efforts so far.

"On the other hand, I think the federal government — Health Canada and the health authorities — as far as I'm concerned, they're probably a little bit slow trying to take action," he said.

Health Canada announced in February plans to introduce new measures to curb the rising amount of vaping by young people.

The consultations closed in September, "and the Department is now carefully reviewing the comments received," a spokesperson told CBC Radio.

"I think right now we know enough to know that these products should probably be more regulated and steps should be taken so these products are not marketed and put in the hands of teenagers too easily," Laliberté said.

Erin and Laura Dexter with their dog, Millie. Laura Dexter says Millie helped them get through the 'hard week' immediately following Erin's collapse. (Mary-Catherine McIntosh/CBC)

Today, Dexter is feeling much better. She's quit vaping, and is now warning her peers at school, many of whom vape as much nicotine as she did, to do the same.

"I never thought that would ever happen to me. But I see that kids and my friends do it exactly the way I do, and it could happen to them," she said.

"So I really wanted to make sure that they know about it, so they can make their decision to stop or not."


Written by Jonathan Ore. Produced by Sujata Berry and Mary-Catherine McIntosh.

Comments

To encourage thoughtful and respectful conversations, first and last names will appear with each submission to CBC/Radio-Canada's online communities (except in children and youth-oriented communities). Pseudonyms will no longer be permitted.

By submitting a comment, you accept that CBC has the right to reproduce and publish that comment in whole or in part, in any manner CBC chooses. Please note that CBC does not endorse the opinions expressed in comments. Comments on this story are moderated according to our Submission Guidelines. Comments are welcome while open. We reserve the right to close comments at any time.