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The truth about vaping

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Contributor: Dr. Elise Herman, KVH Pediatrics

Vaping

As parents, we are vigilant about so many things- alcohol, drug use, Internet and technology issues. Here’s one more, and one that can fly under the parental radar. Vaping (using an electronic cigarette to inhale a vapor usually containing nicotine) is increasingly common among youth and has become very popular over the last 5 years. 

Currently, more high school students use e-cigarettes then standard cigarettes. Although often touted as helping smokers quit, there is no evidence to support this, and when used by non-smokers, vaping may lead to nicotine addiction. In fact, youth who vape are more likely to use cigarettes or other tobacco products.

E-cigarette liquid typically includes nicotine (although not always), chemicals to vaporize the liquid (like propylene glycol) additives and flavoring. There are also other potentially harmful ingredients, including ultrafine particles that can be inhaled deep into the lungs, formaldehyde, heavy metals (lead, tin, nickel) and flavorants such as diacetyl, a chemical associated with serious lung disease.

Of course nicotine is the biggest concern with vaping because it is clearly a habit-forming drug that has harmful effects on the heart, lungs, kidneys and more.  Immediate effects include increased blood pressure, heart rate and breathing. It is a stimulant so gives the user a surge of adrenaline as well as dopamine, a brain chemical that affects sensations of pleasure and pain. This increased dopamine makes people feel more contented—easy to see how this could become addictive! Additionally, there is a lot of research showing that nicotine causes cancer.

As e-cigarettes do not actually contain tobacco, use of these has been largely unregulated in the US, but this is changing. Some cities have banned their use wherever smoking is prohibited, and other regulations are in the works. States differ in term of who may buy e-cigarettes. In Washington state, the sale of these devices is prohibited to people age 18 and younger.  Online sites, however, may not ask for proof of age. The use of vapor products is prohibited in schools, on playgrounds, on elevators, etc. in our state as well.

Youth frequently favor an e-cigarette is called “JUUL” (pronounced “jewel”). It is popular because it has sleek, small packaging that resembles a flash drive, all the better to easily carry and use.  Easy to hide in a pocket, easy to use even in a school classroom. It is appealing due to its kid-friendly flavors such as mango and mint.  JUUL is very addictive as it contains twice the concentration of nicotine of other ‘e-cigs’. Each  JUUL pod contains the same amount of nicotine as an entire pack of cigarettes. Because of its ease of use, it is increasingly common on high school and college campuses, and users often share with peers, encouraging non-users to try it. Like JUUL, other e-cigarettes may look like household items- an asthma inhaler, a car key fob, a pen.

In terms of having a conversation with your child about vaping, it is good to approach the subject non-judgmentally and not to lecture.  The topic might come up more naturally if it is response to seeing someone vaping or passing an e-cigarette shop. Acknowledge that you realize it is common, often due to the mistaken idea that it is risk free. Remind your child that his/her brain is still developing and that no tobacco product or nicotine is safe. There is a real risk for people who vape to also use tobacco products. If you do use tobacco yourself, being upfront about the health risks to you and the challenge of quitting is important. Emphasize that you do not want your child to face the same problem.

More information including a tip sheet for parents is available at the websites for the U.S Surgeon General and the American Academy of Pediatrics.

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

John & Anne Merrill-Steskal

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John & Anne Merrill-Steskal

When John and Anne Merrill-Steskal went looking for a place to call home, who could have guessed the answer lay at the end of a rainbow?

It was June 1993. John, who attended medical school at the University of Kansas, was finishing a residency in family practice at the University of Wisconsin-Madison.

A fellow resident knew Ellensburg. “So I talked to Dr. Bruce Herman who was recruiting for what was then the Valley Clinic (now KVH Family Medicine-Ellensburg),” John says. “We flew out and fell in love with the place immediately.” Their trip included hiking Manastash Ridge with Herman and his wife Dr. Elise Herman.

“There was this huge rainbow at the top of the ridge,” John says. “It was unforgettable. We were both struck by what a beautiful valley it was. It was as if the rainbow was the icing on the cake, confirmation of our impression of Ellensburg and the area in general.”

After all, the Merrill-Steskals had arrived in search of a college town with a good healthcare system, a strong community and easy access to hiking. Nearly a quarter of a century later the only thing that’s changed is a deepening appreciation for the place they call home.

They live at the base of Manastash Ridge on 20 acres they share with two other families. It’s where they raised their son Gabe, an EHS graduate enrolled at Whitman and currently studying piano in Europe. A 12-year-old golden retriever they call Cascade keeps them company.

John, a veteran of 22 years practicing family medicine, also hikes, gardens, does stained glass and makes bread, while Anne, a physical therapist who has worked for Kittitas Valley Healthcare for 16 years and now specializes in vestibular rehabilitation therapy, enjoys spending time with friends and family, landscaping with native plants, hiking and swimming in mountain lakes.

Still in love with their surroundings, they hike the ridge together three days a week. And both say they’ve found fulfilling careers at KVH.

Anne appreciates the opportunities she’s had within the field of physical therapy both to treat diverse conditions and specialize in a variety of areas. In 2013, with KVH support she advanced her education by completing a doctorate in physical therapy.

As for John, “I really like the people at KVH and I believe KVH strives for high quality care. It’s a supportive organization that wants me to be able to do my job,” he says. An instructor for a student he was precepting once asked if he’d ever had a patient encounter that convinced him family medicine had been the right choice for him. “I have those experiences weekly. I love interacting with people,” John says, beaming. “Family medicine is a perfect fit for me and what I love to do.”

And what he loves to do goes far beyond the exam room.

A Passion for Healthy Communication

Convinced that family physicians “need to get out of their clinics and make their voices heard in their communities,” John leads by example sharing what he calls “a passion for behavior that promotes a healthy lifestyle” through social media and technology.

Since June of 2015, he’s hosted Dr. John’s Radio Show which streams at noon on the first Friday of every month on Ellensburg Community Radio. Last March, John launched a monthly blog. It features short, reader-friendly posts on a variety of subjects ranging from the importance of vaccines to a common sense approach to weight loss, his own experience dealing with cancer, the overuse of antibiotics and the benefits of exercise and getting out into nature.

While one-on-one interactions with patients are the cornerstone for his love of being a doctor, he says the radio show and the blog heighten the enjoyment he finds in practicing medicine.

His efforts haven’t gone unnoticed.

This past spring, he was one of two national recipients of the 2016 American Academy of Family Physicians Vaccine Science Fellowships. The fellowships enable recipients to gain expertise in vaccine science and policy. “It ties right into my interest in promoting behaviors that lead to a healthy life,” he says. “Vaccines have prevented disease and saved more lives than any other aspect of medicine.”

Follow Dr. Merrill-Steskal’s blog at espresso3med.wordpress.com.

Heins

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Heins

Carter Hein is just 6 months old, too young to realize that long before the day he was born, his parents were already looking out for him.

Like many first-time parents-to-be, Penny and John Hein experienced a whirlwind of emotions when they learned in November 2011 that they were expecting. This was, after all, uncharted territory for them. Both believed that top-notch prenatal care from a doctor they could count on to personally guide them through the pregnancy was key to ensuring Carter the best possible start in life. Friends recommended Dr. Bruce Herman of KVH Family Medicine – Ellensburg.

Herman and his nurse, Debbie Perry, are old hands at calming the nerves of expectant parents – and there’s good reason. He delivers about 120 babies a year and has been at the clinic 23 years. She’s got 38 years as a nurse under her belt, 28 of them at the clinic, 13 of them working side-by-side with Herman.

Perry, says Penny, “was nurturing and motherly. As for Herman, “Within ten minutes of meeting Dr. Herman you could tell he really was interested in his patients, that he loved people and cared about them,” John says. “He was warm, personable and informative. Any nervousness we had quickly disappeared.” Herman and Perry both encouraged Penny to call at any time if she had questions or concerns. More than once, Penny did.

Herman, the Heins say, has a talent for making expectant parents feel special. “We learned something new at each visit and he explained things in a way we would understand, outlining our options, recommending what he thought would be best but ultimately let us decide what was the best fit for us,” Penny says. “It was very personal.”

With normal pregnancies, patients meet with Perry and with Herman in the clinic about fourteen times prior to delivery. Regular office visits involve blood pressure monitoring, weight checks, growth measurements, checks of fetal heart tones and checks for sugar and protein in the urine. At certain points, there also are checks for increased risk of congenital abnormalities and gestational diabetes. In addition, Herman sees the patient twice at KVH Hospital for ultrasounds.

Heins

Despite the number of pregnancies handled annually in the practice, Perry says there’s something special about each one. “Pregnancy is such an amazing, incredible process and unique every time,” she says, noting that often something as simple as a touch on the arm or lending an ear helps build connection with patients. And while she helps educate and guide patients, she also learns from them, she says.

By the time Penny entered KVH Hospital last July 30, Penny and John felt well prepared and grateful for prenatal care they say was everything they’d hoped for. The following day, Carter weighed in at solid eight pounds five ounces.

“I couldn’t take my eyes off him,” John says proudly.

Truth is, sometimes he still can’t.

Sydney Skistad

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Sydney Skistad

She’s only 6 years old but Sydney Skistad already knows that you don’t have to get sick to visit the doctor. Sometimes you go to get shots so you won’t get sick. Sometimes you go just to make sure you’re really as well as you’re feeling.

That’s why Sydney, a bright-eyed heartbreaker in the making, visited Dr. Bruce Herman’s office at KVH Family Medicine – Ellensburg for a check up this fall. “It was good,” she says.”He checked my heart. He checked my ears. He checked down my throat – it tickled. He checked everything to make sure it was good. Everything was good!”

And then?

“Then I got a sticker,” Sydney says, flashing a smile as her 3-year-old sister Charlotte – decked out as Rapunzel – dances through the living room of the Skistad home.

Dr. Herman and his staff, as it happens, are no strangers to stickers. Debra Perry, who has spent 27 of her 37 years as a registered nurse at KVH Family Medicine – Ellensburg, has handed out plenty of them. “In our practice alone we use about 1,200 stickers per year, one sticker per shot and a sticker for each child after visits,” she says.

Kids get the exams and the stickers. Perry gets the joy of working with the kids and their families. “Kids teach me something new every time I interact with them and with the people they love,” she says. “I love their honesty. Because I’ve been at the clinic as long as I have it’s been an incredible ride watching them grow up.”

Dr. Herman says well child care begins in the hospital with a newborn exam, hearing screening, screening for genetic diseases and immunization planning. Regular office visits soon follow, the first just a few days after birth, the next a week or so later. Then come exams at two, four, six and sometimes nine months followed by exams at fifteen and twenty-four months. Barring problems, visits are annual after that.

Sydney Skistad

The aim is to follow the infant’s growth and development, catching significant problems as early as possible. Regular well child exams can reveal a wide range of conditions from delays in growth or development to undescended testicles, hernias and hip dislocations or other problems. Along the way, Herman and his staff provide support and guidance for new parents on issues ranging from immunizations to preventing illness.

Denee Skistad, Sydney and Charlotte’s mother, as adept at wielding a thermometer or tackling an upset tummy or earache as any mom, understands why parents sometimes find it difficult to make a well child checkup a priority. But even when a child isn’t sick there’s a certain assurance that comes from a well child checkup, she says.

“It’s tempting not to go because there’s no immediate problem,” Skistad says. “But it’s an opportunity for the doctor to check a child’s health for things that aren’t always obvious. “It’s knowing that there’s not something there that you’re missing or you can’t see. It really is about peace of mind.”