When Dalton Stiltner first felt short of breath early last month, he chalked it up to anxiety.
The 21-year-old senior and college athlete at the University of Pikeville has anxiety that has, in the past, progressed to the point of heart palpitations and shortness of breath, he said.
These days, he’s still relatively stressed. A full-time student on the brink of adulthood, each weekday is devoted to class and running at least five miles on his university cross country team. On the weekends, when he’s not traveling to cross country meets, he works part-time making sandwiches at Jimmy Johns.
Stiltner is lanky, at 6’1 and 145 pounds, and he’s been running long distances competitively since he was in middle school. He eats a relative amount of fast food, like most college-age kids, but is otherwise a pillar of cardiac and respiratory health.
For about a year, he’s also been vaping with a device manufactured by the popular brand JUUL Labs. As the largest e-cigarette company in the country, JUUL is facing a groundswell of scrutiny after hundreds of young people suffering from vaping-related respiratory illnesses began filling emergency rooms and hospitals last month in almost every state.
Stiltner was surprised to be one of them. His shortness of breath would later progress into sharp chest pain, he said, landing him in the Pikeville emergency room, where he found out why: his lung had collapsed.
Many have been hospitalized with severe symptoms from nicotine and THC vaping, some required breathing assistance, and many, like Stiltner, had otherwise clean bills of health. Roughly 80 percent of the more than 1,000 people who’ve gotten sick so far are under the age of 34, according to the Centers for Disease Control and Prevention.
JUUL opponents have long argued the company deceptively markets its highly-addictive products to teenagers and young adults with tailored ads and fruity flavors.
Stiltner’s favorite flavors — part of the reason he started vaping in the first place — are mango and crème brûlée. But even when JUUL pulled those flavors from store shelves late last year, he didn’t stop vaping.
“I was already addicted at that point, so I just started buying mint and menthol,” he said.
Different from a lit tobacco cigarette, Stiltner’s e-cigarette, also known as a vape pen, is a sleek rechargeable device that looks like a USB drive. It allows him to smoke flavored nicotine-laced heated liquid from a pod, and produces a scented vapor instead of smoke.
Before he started vaping, Stiltner didn’t dip or smoke cigarettes. Smoking, he thought, would’ve hurt his ability to train in the way he needs to for cross country. Neither did most of his friends, though “almost all” of them now JUUL, he said in his family’s Pikeville home last week, alongside his mom, Lisa Justice.
“I’d always heard that it wasn’t as bad as cigarettes,” he said. Plus, “cigarettes have this stigma and smell bad. But with JUUL, they taste good and the flavors even smell good.”
This has been a point of contention between the e-cigarette company and its opponents since these devices hit the shelves in 2015: JUUL’s outward facing message, reiterated by the company to the Herald-Leader earlier this month, is that their products have always been reserved for former nicotine users.
“We have never marketed to youth and do not want any non-nicotine users to try our product,” the company said.
But opponents point to mounting evidence that suggests otherwise, especially as use among teens and young adults like Stiltner continues to soar. Early CDC data show roughly 28 percent of high schoolers reported vaping in the last month. Of the 1,080 people who’ve been sickened, 21 percent are between the ages of 18 and 20, and 16 percent are under 18.
Stiltner, who started when he was 20, goes through about a pod a day, which is, by JUUL’s own admission, the equivalent nicotine intake of smoking at least a pack of cigarettes.
“It was always in my hand. I would hit it as soon as I woke up,” Stiltner said.
So earlier this month, when his shortness of breath persisted for several days, he started to wonder if vaping was playing a part.
“It wasn’t typical, because I’m really in shape from running so much,” he said.
Then, on the afternoon of Friday, Sept. 14 while he was in his room, he hit his JUUL, exhaled, and immediately felt a searing pain under his rib cage.
“It felt like a hot knife was sticking out of my chest,” Stilton remembers.
The pain, concentrated on his left side, eventually dulled but never went away fully, and his shortness of breath didn’t either. The pain would sharpen when he bent over or lifted his left arm, and later that night, it prevented him from sleeping on his left side.
Stiltner was still planning to run in his cross-country meet the following morning, but when he woke up with the same symptoms, his coach told him to sit out. His mom made him to go to a Walmart health clinic that afternoon, but a nurse practitioner found nothing out of the ordinary.
That evening, he went to work. A home UPike football game brought a surge in sandwich orders, so the pace of work was fast, he remembers. At one point, he had to pull a bucket out of the back to sit on. He couldn’t catch his breath.
He told his mom later that night what happened, and the following morning, they skipped church and went straight to the Pikeville Medical Center emergency room.
It was there that doctors discovered his left lung had totally collapsed, putting his overall lung capacity at 22 percent, he and his mom said. Normal capacity for someone like Stiltner is upwards of 80 percent.
When his doctor saw his crumpled lung on an CT scan, “he asked if I vaped,” said Stiltner, who was eventually admitted for surgery to reinflate his lung. He spent two nights and three days in the hospital.
If Stiltner had competed in his meet on Saturday, it could’ve had grave consequences, Stilter and Justice said the doctor told them. His doctor and the spokesperson for Pikeville Medical Center did not return multiple calls and emails seeking comment.
Now, Stiltner’s college cross country career is over, as is his vaping habit. Smoking of any kind in the future would almost guarantee another collapse of one or both of his lungs. Stiltner said he was told another reinflation procedure would leave lasting damage, maybe even requiring the removal of part of his lung.
‘No stoppage to it’
Stiltner’s health scare from vaping is one of nearly 1,100 similar cases that have cropped up in recent weeks across 48 states, according to the most recent numbers from the CDC. Eighteen people have died. Those affected are mostly teenagers and young adults.
Acknowledging vaping to be an epidemic among Kentucky youth, several state lawmakers announced a proposal to tax all vaping products beginning next year, commensurate with the tax on tobacco cigarettes, in order to cut use among Kentucky youth and pregnant women — the two demographics who vape the most — and generate an estimated $35 million annually for the state’s General Fund.
Kentucky is currently investigating 25 cases of possible pulmonary disease from vaping, with one confirmed and three probable cases. Cabinet for Health and Family Services officials won’t confirm specifics of the cases that are being investigated — including whether one of them is Stiltner’s — except for the lone confirmed case, which involved a man in his early 30s with a history of e-cigarette use.
On Sept. 3, the Cabinet sent a letter to all state health care providers encouraging them to report any vaping-related illnesses they treat, but it’s not mandatory.
Around that time in early September, the White House and federal Food and Drug Administration, backed by the CDC, moved to ban all remaining flavored e-cigarettes. Two weeks later, JUUL said it would comply and additionally announced it was stopping all product advertising for the time being. That same day, JUUL CEO Kevin Burns resigned.
The CDC issued an urgent warning last week before the U.S. House Committee Oversight and Reform for everyone to stop vaping. Officials in Louisville last week began pushing the same message. Some states are going further, including Massachusetts, which has banned the products for four months.
In a news release issued Tuesday, Elizabeth Anderson-Hoagland of the Kentucky Chronic Disease Program said until health officials better understand the root cause of the state’s vaping illnesses, “we strongly urge Kentuckians to avoid any vaping products.”
Meanwhile, the tally of vaping-related illnesses continues to climb.
But doctors still aren’t sure which part of the vaping liquid is causing respiratory issues in so many. Crack open one of these pods and one will find an oily liquid that contains heavy metals and other harmful chemicals, said Dr. Mehdi Khosravi, a University of Kentucky pulminologist who has studied vaping’s effects on the respiratory system.
The oily nature of the vaping juice, alone, can be cause for concern, he said. Part of what makes it oily is vegetable glycerin and propylene glycol — two odorless, viscous liquids that help dissolve nicotine, which isn’t water soluble. Regularly ingesting these even outside of vaping is known to cause asthma-like symptoms, Khosravi said. Similar to someone with lipid pneumonia, the oily residue will collect inside the lungs, potentially causing inflammation, trouble breathing and, long term, lung disease.
Though e-cig manufacturers tout their products as containing fewer carcinogens, there are still known cancer-causing agents in the liquid, according to the CDC — Khosravi likened a vape pen to a “diluted cigarette.” But when factoring a spike in how often vape pens are smoked by a user compared with cigarettes, the devices can carry potentially as much, albeit different, potency.
“People that use e-cigarettes, on average, take puffs that are around four-times as deep and four-times longer than the regular puff of a cigarette smoker,” he said. That’s partially because e-cigarette vapor is smoother than cigarette smoke, and users aren’t contending with heated smoke from a lit cigarette. Also, unlike cigarettes, one doesn’t have to keep lighting a vape pen to continue smoking it. Since one pod equals up to 500 puffs, there’s virtually “no stoppage to it,” Khosravi said.
‘No buzz is worth this’
Since he was released from the hospital, Stiltner’s family has hired Louisville-based attorney Leslie Cronen, who’s in the early stages of potentially filing a lawsuit against JUUL with several plaintiffs from Kentucky. Cronen said she already has multiple clients interested in filing, though she wouldn’t say how many.
“For somebody like Dalton, who was never a smoker and who probably would have never picked up a regular cigarette,” JUUL’s marketing campaign “did exactly what it intended to do — bring in a new group of consumers. That’s where Dalton fits in,” Cronen said.
JUUL told the Herald-Leader late last month that “our product has always only been intended to be a viable alternative for the one billion current adult smokers in the world.”
Justice, Stilton’s mom, said she feels hoodwinked. “Had I, for a second, thought it would cause him bodily harm like this, I definitely would’ve taken drastic measures to make him stop,” she said.
Now, her family feels a responsibility to talk about his experience publicly to “get the word out there, and hopefully get this off the market so what happened to Dalton doesn’t happen to other people.”
Despite his nicotine withdrawals, Stiltner knows he’ll never vape again. He’s become an anti-vaping evangelist, even going so far as to post a video on Instagram of him tossing his leftover pods and his JUUL into a fire he set in a wheelbarrow in his backyard.
“I wake up in the morning still reaching for my JUUL, but I know I’m never going to do it again because the pain was the worst of my life,” he said. “No buzz is worth going through all this.”