So, this e-cigarette thing & vaping nicotine liquid. Contributor?

I know you must be wondering a few things.  What is an e-cigarette?  What is vaping? Nicotine liquid?  And why in the world did she choose a pina colada as the image for this post?

In order:  An alternative to smoking traditional cigarettes (or "analogs" as they're commonly referred to within the "vaping" community), an electronic cigarette, or e-cig, is actually a bit like a small fog machine.  It heats liquid - either with or without nicotine - to a vapor, which can be inhaled and exhaled like cigarette smoke.  We "vapers" refer to that act as "vaping."

Why the pina colada? Because unlike traditional cigarettes, liquid nicotine comes in many tasty flavors - as many as you could possibly imagine.  If you can think it, someone has probably added FlavourArt liquid flavoring - such as would be used in the commercial beverage industry - to a nicotine and vegetable glycerine base.  My favorite for several months was, you guessed it, pina colada.

The trouble is, I've learned two things since I first picked up an e-cig (and put down the cigarettes the same day), one is that while the flavorings are on the generally recognized as safe (GRAS) list for ingestion, several are definitely not safe for warming to a vapor and inhaling.  In particular, one compound called diacetyl, a diketone, which produces a buttery or creamy flavor and was very popular in several "nicotine juice" flavoring concoctions is also known to cause a disease called Bronchiolitis Obliterans, aka "popcorn lung."  Essentially, the warmed vapor is known to cause irreversible lung damage.  But vendors still used it, and buyers still bought it.  There is/was quite a bit of debate over whether the compound was safe in the minuscule amounts that e-cig users were probably receiving.  

Which would seem to have nothing to do with anything.  Except, after six months of vaping, I came down with my transverse myelitis lesion.  And in my research came across this article on b12 deficiency-related paresthesia and myelopathy (which may mimic or lead to TM-like lesions and was curable with b12 injections):  http://www.mayoclinicproceedings.com/content/77/3/291.full.pdf 

In short, what caught my eye was that hexanedione is listed as a known neurological toxin.  Hexanedione is in the same compound description as diacetyl, they are both diketones - it is also used as a flavoring which can produce a buttery or creamy taste.

So it begged the question - was there a chance that my TM was not actually idiopathic, but had a definable cause, right in my hand?  No flavoring vendor that I am aware of used hexanedione specifically.  But 2,3 pentanedione was used, and as you may have guessed by that "dione" suffix, is another diketone.  It would seem that direct inhalation of diketones wouldn't be the best idea under any circumstances.

Additionally, I came across information that nicotine inhibits b12 absorption, and wondered if in fact there is something about the way that e-cig users absorb nicotine that further interferes with b12 absorption.

And as if this isn't long and "what if?" enough... The e-cig itself uses what is referred to as an atomizer (or alternately, cartomizer) to actually heat the liquid.  And how are the atomizer parts constructed?  With solder, of course.  Everyone recognizes that using lead solder would be a very bad idea, indeed, and instead a common replacement is silver/tin based solder.  And you know what is also a neurotoxin?  Heavy metal poisoning, such as by silver.

Thankfully some "cartomizers" are coming out now that are solder-free, so perhaps that is at least one less thing to worry about.  But that's the problem with an idiopathic diagnosis - we just don't know what caused it, and all I can do is continue to guess.

In short, I feel as if I might be something of the canary in a coal mine, and am simply the first of others who might encounter neurological damage due to their desire to reduce the harm caused by cigarette smoking.

Pins & Needles, pt. 3

In a short time, Dr. Brian has spoiled me by acting as a partner to my care.  He encourages me to print what I've found on Medline or the Mayo Clinic site so that we're on the same page.  He listens.  But most important of all, I can tell that he trusts my judgment.  I may not have had eight years of medical school, but I'm on something close to even footing with him.  He isn't shy about admitting what he doesn't know, which is disconcerting and comforting at once.  But as he put it, "I shouldn't have come across a case like this in my practice... ever."  


If you wonder at the ease of familiarity I have with Dr. Brian, consider that he is also, more or less, my neighbor.  We live in a very small town in rural western Texas.  Population 1,611 is what the sign says, but with the new census numbers coming out we're sure to strike a few off that number.  Cotton farming doesn't exactly have the draw it once had, and our other major industry, gypsum wallboard manufacturing, has gotten so good at eliminating extraneous personnel that two jobs are eliminated roughly every year.  I know this because Chuck works at the "gyp mill."  For a quick Dirty Jobs rundown: gypsum rock - actual rock, mined from a nearby gypsum seam - is crushed and reconstituted into a slurry.  From there it is poured onto huge rolls of paper and run through the kiln where it re-crystallizes and is cut into sheets of now-wallboard (you may know it as SHEETROCK® - we never call it that, as he doesn't work for the trademark-protector of that name, USG).  It's hard work, with good insurance.  Thank goodness.

After my meeting with Dr. Baker, I am quick to schedule an appointment with Dr. Brian.  For a woman who had last been to a doctor for a muscle spasm some six years prior it's a bit overwhelming how quickly I became accustomed to the offices, the lab techs & their quest to find a good vein, the smells.  (Before you ask, yes, I should've been in for at least a PAP.  I will schedule one soon. That's my personal litany: "I will schedule one soon..." just as with any other prayer I feel the mere mention will stave off trouble.)  With my health suddenly the primary focus of everything and everyone I begin to feel... old.

Awaiting my followup with Dr. Brian I google.  Transverse Myelitis (TM) is a condition in which the immune system attacks the myelin sheath.  Essentially a protective coating, the myelin sheath's job is to buffer the nerves in the spinal cord.  TM causes this sheath to wear thin, exposing the nerves and allowing damage.  I am nothing less than terrified and shocked to learn that TM can cause paralysis and permanent long-term damage.  Once that sheath is gone, it's gone.  And TM is frequently a precursor to an MS diagnosis.  There is nothing here to soothe my fear.  The best news I find is that of those who suffer from TM, about 1/3rd recover fully, 1/3rd recover to some extent, and 1/3rd see no significant recovery.  I also learn that roughly 1,400 cases of TM are diagnosed each year in the United States.  Surely, surely that stacks the odds against my having this disease.

My body has never gone off the beaten path before, always churning and chugging away at doing what it's meant to do so I turn my attention fully to B12, the e-cigarette, and the upcoming MRI.

Pins & needles, pt.4

Pins & Needles, pt. 1

That's how it all started, as we readied for our eldest to make his first "real" trip home since leaving for Texas A&M: Christmas break.

I used my laptop in the kitchen, where you'd find me sitting on a high stool, the "e-cigarette" (a nicotine delivery device I'd used since the previous summer as a replacement for cigarettes) in one hand, frequently resting my elbow on the counter as I browsed.  The mild numbness and tingling I felt in my left pinky and ring finger were easy to write off as a pinched nerve.  I moved the laptop and hoped for the best.

As with every other problem in my life I've tried to fix by ignoring... it didn't work.  By Friday, December 9th, 2010, the numbness and tingling was joined by a feeling of heaviness in my left arm, and what I could only describe as having a second layer of skin - I could process hot and cold, pain or pressure, it was all just a bit... off.  The wiring felt fuzzy.  I expertly continued to ignore the problem.  Finally, as the feeling spread to my right arm and shoulders, I nagged my husband to massage the ever-present knots in my back and neck.  Just stress and the aftermath of a flu, I told myself and everyone else.  By Monday it had spread to my torso and legs, leaving everything from the neck down with that second-skin feeling, along with a feeling of electricity coursing through my entire body.  Even I couldn't ignore that, and by Tuesday I had an appointment with our local Nurse Practitioner.

Let me give you my prior medical history as told to the NP:  _________________________.  In a nutshell, though I'd smoked for over twenty years, I was almost ridiculously healthy.  Low blood pressure, great cholesterol, clean chest x-rays (taken that day), etc.  In 40 years the only real hiccup had been an emergency c-section with my second child.  So when I walked in expecting to leave with a prescription for muscle relaxants, I'm sure you'll indulge my ignorance.

Instead I left with a referral to a neurologist.  I didn't call her immediately, instead opting to make an appointment with our trusted local Family Practitioner, Dr. Brian Carreon.  Younger than I, with a warm, engaging personality tailor-made for family practice, Dr. Carreon (or Dr. Brian, as he's referred to in our house) listened intently as I shared what I'd learned from my previous favorite doctor - Dr. Google - that my borderline low B12 levels might be causing an issue.  He agreed, we started B12 injections, and I dutifully followed his recommendation to make the appointment with the previously-referred neurologist.

Pins and Needles, pt. 2