GURNEE, Illinois — Adam Hergenreder’s vaping habit almost killed him.
In late August, the 18-year-old student-athlete in Gurnee, Illinois, was hospitalized after using e-cigarettes for more than a year and a half. Doctors told him his lungs were similar to those of a 70-year-old.
“It was scary to think about that — that little device did that to my lungs,” Hergenreder said, remembering the news from his doctors about his lung health.
Hergenreder was among the hundreds of e-cigarette users in the United States sickened with mysterious vaping-related lung illnesses, many of them young people. Investigators haven’t identified the cause of the illnesses.
Amid calls for more regulation, President Donald Trump’s administration plans to remove flavored e-cigarettes — except tobacco flavor — from the marketplace.
“Why is that important? We are seeing an absolute surge in high school and middle school kids using these flavored products,” U.S. Health and Human Services Secretary Alex Azar said in a video statement on Wednesday, Sept. 11. “Mint, menthol, fruit flavor, alcohol flavor, bubble gum.”
The U.S. Food and Drug Administration announced on Wednesday that more than a quarter of high school students reported using e-cigarettes in 2019, and the “overwhelming majority” reference using popular fruit and menthol or mint flavors, according to preliminary data from the National Youth Tobacco Survey.
Hergenreder said he wasn’t sure his lungs would ever be back at 100% — worried whether he would ever be able to wrestle again.
“I was a varsity wrestler before this, and I might not ever be able to wrestle, because that’s a very physical sport, and my lungs might not be able to hold that exertion. It’s sad,” Hergenreder said.
‘We must act swiftly’
More than 450 possible cases of lung illness associated with using e-cigarettes were reported across the United States, according to the U.S. Centers for Disease Control and Prevention, which has called this an “outbreak.”
Health officials also confirmed six deaths — in California, Illinois, Indiana, Minnesota, Oregon, and Kansas — in connection to vaping-related lung illnesses.
While the illnesses and deaths occurred in both young people and older adults, experts warned of a rise in vaping among youth.
“We must act swiftly against flavored e-cigarette products that are especially attractive to children,” Acting FDA Commissioner Dr. Ned Sharpless said in the announcement, adding that the FDA would take additional steps to address youth use of tobacco-flavored products still on the market, if young people begin to use them.
“The tremendous progress we’ve made in reducing youth tobacco use in the U.S. is jeopardized by this onslaught of e-cigarette use. Nobody wants to see children becoming addicted to nicotine, and we will continue to use the full scope of our regulatory authority thoughtfully and thoroughly to tackle this mounting public health crisis,” he said.
Separate surveys also suggested that most teens think e-cigarettes are safe.
Hergenreder certainly thought vaping was safe when he started using e-cigarettes, he said. One of his favorite flavors was mango.
‘It tasted good and it gave a little head high’
“I first started vaping just to fit in, because everyone else was doing it,” Hergenreder said, adding that the flavors appealed to him, especially mango.
“It didn’t taste like a cigarette,” he said. “It tasted good,” and provided a little buzz due to the nicotine.
The vaping began about a year and a half ago, he said, and he would pick up e-cigarette products, such as those of the Juul brand, from his neighborhood gas station.
“They didn’t card me,” he said.
“He would wake up in the morning and would puff on that Juul and then cough,” said Hergenreder’s mother, Polly Hergenreder. “He would hit it several times throughout the day. My son was going through a pod and a half every other day, or a day and a half.”
Experts said that one Juul pod — a cartridge of nicotine-rich liquid that users plug into the dominant e-cig brand — delivers the same amount of nicotine to the body as a pack of cigarettes. “That’s smoking a lot of cigarettes,” Polly Hergenreder said.
Eventually, Adam Hergenreder said that he went from vaping over-the-counter e-liquids to vaping THC or tetrahydrocannabinol, which is the main psychoactive component of marijuana. Hergenreder would get the THC from “a friend” or dealer.
Over time, Hergenreder said that he developed shivers and couldn’t control them. Then, the vomiting began.
“I was just nonstop throwing up every day for three days,” he said. “Finally, I went to the pediatrician.”
At first, doctors did not connect Hergenreder’s symptoms to his vaping. He was given anti-nausea medication, but he said that his vomiting did not stop. After visiting various physicians, he finally saw someone who asked if he was “Juul-ing” and using THC.
“I answered honestly,” Hergenreder said. “I said I was.”
The team overseeing Hergenreder’s care performed a CT scan of his stomach and noticed something unusual about the lower portion of his lungs. The doctors then took an X-ray of his lungs.
“That’s when they saw the full damage,” Hergenreder said. “If I had known what it was doing to my body, I would have never even touched it, but I didn’t know,” he said about vaping. “I wasn’t educated.”
‘If we did not bring Adam in … his lungs would have collapsed’
Hergenreder was admitted to the hospital in late August.
“If his mom had not brought him to the hospital within the next two to three days, his breathing could have worsened to the point that he could have died if he didn’t seek medical care,” said Dr. Stephen Amesbury, a pulmonologist and critical care physician at Advocate Condell Medical Center in Illinois, who was one of the doctors who saw Adam.
“It was severe lung disease, especially for a young person. He was short of breath. He was breathing heavily,” Amesbury said. “It was very concerning that he would have significant lung damage and possibly some residual changes after he heals from this.”
Hergenreder’s mother spent the following six days in the hospital with her son, who was connected to IVs and was provided oxygen through nasal tubes.
“The doctors did tell us that if we did not bring Adam in when we brought him in, his lungs would have collapsed and he would have died,” Polly Hergenreder said.
Yet, she added, “you should always try to find the silver lining,” and for her family, that is to use Hergenreder’s experience to educate others about the risks of vaping.
Hergenreder was released from the hospital and, “It’s still difficult to even do normal activities, like going upstairs. I still get winded from that,” he said.
Even though he was still recovering — including doing breathing treatments — Hergenreder focused on sharing his story. Through his advocacy, he said that he has even convinced some of his friends to stop vaping.
“I’m getting better each day,” he said. “I don’t want to see anybody in my situation. I don’t want to see anybody in the hospital for as long as I was.”
The federal investigation into the link between vaping and severe lung illnesses was ongoing, but all reported cases have indicated the use of e-cigarette products and some patients have reported using e-cigarettes containing cannabinoid products, such as THC.
There were also separate investigations being conducted in separate states.
New York health officials said extremely high levels of the chemical vitamin E acetate were found in nearly all cannabis-containing vaping products that were analyzed as part of the investigation. At least one vape product containing this chemical was linked to each person who fell ill and submitted a product for testing in the state.
Laboratory tests conducted at the New York State Department of Health’s Wadsworth Center in Albany showed “very high levels” of vitamin E acetate in the cannabis-containing samples, the state health department announced.
Vitamin E acetate was “a key focus” of the state’s investigation into the illnesses, the New York Department of Health said. Some of the products found to contain vitamin E acetate were candy-flavored vapes.
‘There really isn’t enough vaping history to say what’s going to happen’
Juul maintained that its products are intended to convert adult smokers to what it described in the past as a less-harmful alternative. In other communications, company officials said they could not make claims the products are safer, in line with FDA regulations.
Scientists pointed out that they were still learning about the long-term health effects of e-cigarettes. One study published in the Journal of the American College of Cardiology in May found that e-cigarette flavors can damage the cells that line your blood vessels and perhaps your heart health down the line.
Another study, published in the journal Radiology in August, found that vaping temporarily impacts blood vessel function in healthy people. Using MRI scans, it found, for example, changes in blood flow within the femoral artery in the leg after just one use. The researchers couldn’t determine which chemical might be responsible for the changes they observed.
There are many questions that remain to be answered, according to Amesbury.
“We’re very early in the stages of finding out what problems may come up from vaping,” he said. “We’re finding these acute, severe illnesses now, but there really isn’t enough vaping history to say what’s going to happen 10, 20, 30 years down the road.”