Dr. Tom Viola has been on the podcast before and in this TIPisode he highlights some great points about vaping. This is a hot topic these days and we need to be armed with as much info as possible to best educate our patients.
With over 30 years’ experience as a pharmacist, educator, speaker and author, Tom Viola, R.Ph., C.C.P. has earned his reputation as the go-to specialist for delivering quality continuing education content through his informative engaging presentations. Tom’s sellout programs provide an overview of the most prevalent oral and systemic diseases and the most frequently prescribed drugs used in their treatment. Special emphasis is given to dental considerations and strategies for effective patient care planning.
Tom’s homepage – http://www.tomviola.com/
Pharmacology Declassified – http://www.tomviola.com/welcome-to-the-pharmacology-declassified-blog/
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For your viewing pleasure this TIPisode has been transcribed:
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date, and presented by the experts in the profession. Now, get ready for your unofficial TIPisode.
Tom Viola: Hey, everyone. This is Tom Viola from Pharmacology Declassified and tomviola.com. Thank you so much for being a part of this TIPisode with me today. Recently, I presented a continuing education seminar for a dental hygienist at one of their national meetings, and a dental hygienist came up to me at the end of my presentation to thank me and introduce herself, and she said, “Oh, I know you. You’re that vaping guy.” I’m the vaping guy? Well, I didn’t know what to quite make of that, so I asked her to explain, and she said, “Well, I read your blog all the time on your website, and you post consistently about vaping, and I really find it fascinating.”
I’ve been a pharmacist for over 30 years, and I remember when the first e-cigarette was introduced in 2003. It piqued my interest. Why? Well, first, because it was new technology, right? I mean, I am one of those geeks out there that loves tech, so I was interested in how it all works. But what really piqued my interest was it was a new route of administration for delivering nicotine to the lungs, and any route of administration that involves the oral cavity has my attention. Why? Well, because I know that I’m going to be speaking to and teaching dental hygienists about such technologies, if they have effects on the oral cavity.
Underlying that interest was a worry. What was the worry? Well, having been an instructor of pharmacology for hygienists all those years, I knew that dental hygienists run the forefront of the challenges that were involved with tobacco and smoking and smoking cessation — odd, another route of administration for delivering nicotine to the lungs — and so the underlying worry was, “Hmm, is this tobacco all over again? Are we facing another tobacco challenge?” But I kept that under wraps. Why? It’s 2003. The technology’s brand new. We would need to see long-term what the effects are.
But that became another worry because it took us all those years to figure out the effects of tobacco, and now, with this new technology, I knew we’d have to wait years to see the short-term and long-term effects. That scared me because, in that time frame, our patients might suffer, but not much we can do.
So how did I become that vaping guy? I’ve followed along all these 16 years and collected the data and read and watched as more and more information became available.
So I’m doing this TIPisode with you today because I want you to be knowledgeable of vaping. Why? Well, I couldn’t think of another health care professional that would necessarily need to be more knowledgeable about vaping than you because dental hygienists are the first to see the effects. You’re on the forefront for a reason. You’re the first one the see the effects of vaping, and you need to be as knowledgeable about it as possible.
I hope I can share some of the knowledge I’ve accumulated over time with you today, but it’s so vast — it’s so much information I couldn’t possibly share it with you in a mere few minutes, so I wanted to give you the highlights. I wanted to give you what’s new — what’s the ongoing issues with vaping that we’ve uncovered so that you can take that information and grow it.
So what’s going on right now? Well, first off, some troubling news from the Centers for Disease Control, the CDC. They’re looking at outbreaks of respiratory illness right now in 14 states that they believe are associated with vaping. Well, the CDC has looked at these cases, and they have determined that there’s really no infectious disease or other etiology behind these illnesses. The only common denominator is vaping. What do we know about this? The syndrome — again, identified so far in 94 patients since June but obviously more coming — is a severe lung disease tied to vaping with 30 individuals in Wisconsin identified alone.
Okay. Time to take a pause because retrospective analysis can be dangerous, and no better analogy I can use than the opioid crisis. Looking back at people retrospectively who, unfortunately, became addicted to opioids, many of them had received a prescription for an opioid analgesic in their early adolescent years for a routine third molar extraction. Now, they later became addicted to opioids, but this is where retrospective analysis gets dangerous because is there a direct correlation between that first prescription for an opioid and their subsequent opioid addiction? That’s [sic] involves more research.
Same here. We see these illnesses. We can’t identify them. We know these folks have one thing in common: they all vape. Is vaping the cause of this illness? Well, what do we know about the illness? Here’s where you shine, my friends the hygienists. Symptoms. Coughing, fatigue, shortness of breath. What’s most, I’d say, interesting about this is the demographic. Who are these patients that are affected? They’re not the typical patient you might associate with shortness of breath, fatigue, and coughing. These are teenagers and young adults who’ve presented with symptoms that are so severe they required artificial ventilation. Some of the patients actually presented with anorexia and what the CDC described as “ground-glass opacities” in their lungs.
Again, right now, the State Health Department in Wisconsin and other states and the CDC are declining further comment because they need more information, and so they’re not releasing any further details, but that’s one point. Take that. Follow up with it. Grow it, my friends, because more to come.
What else? Well, how about a possible first-ever vaping-related death. On August 23rd of 2019, Health Department officials in Illinois confirmed the death of one patient in a cluster of individuals with respiratory diseases, again, being investigated by the CDC. Now, specific identifying details have not yet been release, but the patient is described as 1 of 22 patients in Illinois suffering from this ailment and — again, here’s the interesting part — the patient ages range from 17 to 38 years old. One more time, a demographic we don’t typically except to see associated with such severe respiratory illness.
What else? Well, here’s my third point. Neurologic risks. The FDA, right now, is investigating 127 reports of possible links between seizures and what they call “other neurologic symptoms in patients who use nicotine vaping devices.” That number was accurate as of August 7, and it may have grown since then, especially since the investigation began in April based on just 35 reports. What kind of symptoms? Fainting, tremors — but here it is again — in both adult and young users.
Okay. Time to take a pause because these symptoms can be traced back to as early as 2010. We’ve already talked about problems with retrospective analysis. So, here, the FDA has taken a step forward and asked public — asked health care workers to report any and all information in detail about seizures and other neurologic symptoms that may be associated with e-cigarette use. One more time, my friends you hygienists, here’s your opportunity to shine. If you’ve got patients with these symptoms, here’s a chance to make a difference in their lives. Here’s a chance to maybe save a life. And I know you do that every day.
Last point on vaping for this TIPisode. The issue of compromised blood vessels in patients that vape liquids that don’t even contain any active ingredients like nicotine or cannabis. Yes. Definitely interesting and somewhat unsettling news about the pure biomechanics of vaping, again, without an active. This is thanks to a recent study that investigated the vascular effects of nicotine-free vaping conducted at the University of Pennsylvania. What did they find? Well, essentially, they found that using e-cigarettes vaping is not equivalent to just merely inhaling water vapor. In fact, it exerts, as they put it, “acute detrimental effects on blood vessels, again, even when the liquid does not contain any actives.”
Now, this was based on earlier research that showed oxidative stress and inflammation in blood vessels for hours after vaping. And, in this case, the researchers used MRI technology to measure the vascular function in 31 healthy, non-smoking adults who took 16, 3-second puffs of a nicotine-free vaping liquid that was formulated from propylene glycol, glycerol, and flavorings. The results? The blood vessel reactivity of these subjects was, in their opinion, considerably and significantly impaired after just one vaping session in people who are non-smokers. Hmm. Oxidative stress and inflammation in blood vessels. Sound familiar, my friends you hygienists?
So, with these studies, as with all studies, nothing conclusive yet. They shouldn’t be used to confirm an association between vaping and any specific illness, again, because we need more information and more data. They’re suggestive, and it helps lead us in the direction of needing and wanting and almost demanding further aggressive study, but we don’t know yet everything we need to know about it.
Easy for me to say. Why? Because the problem is, while we’re waiting for that research, patients are suffering these detrimental effects. And it pains me to think that the only way we’ll get this information is to watch our patients suffer.
Well, thank you, everyone, for being a part of this TIPisode with me today. I know how busy you are, and for you to take time out of your busy schedule to listen to me makes me happy.
A special thank you to Michelle and Andrew. I love what you guys are doing with A Tale of Two Hygienists, and I love being part of both the TIPisodes and our podcasts. Let’s do more. You know I love you guys, and I’d do anything for you.
Again, this is Tom Viola from Pharmacology Declassified and tomviola.com. I look forward to seeing you all and hearing from you all. Thank you for your time.
Michelle Strange: We hope you enjoyed this week’s TIPisode. Be sure to reach out to our guest experts and let them know how helpful their tips were. Follow A Tale of Two Hygienists on Facebook, Instagram, and head over to ataleoftwohygienists.com and subscribe to our newsletter. You can also email us at firstname.lastname@example.org, and keep listening for more awesome content from your unofficial dental hygiene podcast.