Amber Noland fidgets with her black shawl as she recalls the pain she felt as she struggled to take a breath, while nurses and doctors worked fast to reinflate one of her lungs.
"Probably the scariest part was feeling it happen, knowing what happened," the 18-year-old said, sitting next to her mom Tara at their home in southwest Calgary.
What happened was Amber's left lung had completely collapsed.
It was the second time in days Amber's lungs had failed her.
A few days prior, in late October, Amber said she was at home when she started feeling a lot of pain in her chest and started to have trouble breathing. Her mom took her to a clinic and staff there sent her to the emergency department at Rockyview hospital.
Tests showed Amber's left lung had partially collapsed. Staff inserted a chest tube through her ribs and into her chest wall to try to reinflate it. The tube fell out, yet her lung started to slowly improve. But a few days later, her lung collapsed completely, prompting an emergency response and another chest tube.
Tara Noland said the whole time staff kept asking her daughter, "'Do you vape? Do you smoke? Do you smoke pot?'"
"From the second that we're in [emergency] right until her discharge, they talked about vaping, they talked about that she could never do it again and that this possibly could be the reason why this happened," said Tara Noland.
'Every day, all the time'
Amber said she smoked cigarettes as well as tobacco mixed with cannabis before she started vaping nicotine in Grade 11.
She said she started vaping to help her quit smoking and because all her peers were doing it.
But instead of slowing her nicotine habit, the vaping ramped it up.
"Every day, all the time because it's just, like, it's not smoking … you can do it inside and it doesn't really smell," she said.
Amber said in the time leading up to her collapsed lung, she was vaping nic salts containing 50 mg of nicotine — one of the highest doses available — and vaping all day.
She said she would also smoke cannabis mixed with tobacco.
Everyday all the time because it's just, like, it's not smoking … you can do it inside and it doesn't really smell. - Amber Noland
Respirologist Dr. Brandie Walker said smoking is a known risk factor for a spontaneous pneumothorax, which is the sudden collapse of a lung without any apparent cause. She said scientists are not sure why inhaling smoke can cause a pneumothorax and there is not enough evidence yet to know if vaping also increases this risk.
Walker said there was a recent case report in a medical journal describing a young man who vaped prior to developing a pneumothorax. The author suggests either the e-cigarette's toxic chemicals or the sucking action could have contributed to the man's collapsed lung — but that there may have been other factors, too.
Experts say spontaneous pneumothoraces are also more likely to occur in people with a family history, or young adult males with a slim body type.
"Now as a pneumothorax happens spontaneously in some people it would be difficult to say that the reason for having a pneumothorax is related to vaping, but it would be included amongst the list of things that could increase the risk," said Walker.
A new crop of diseases
Alberta and other provinces are only tracking a very specific and severe lung disease related to vaping following an outbreak of similar illnesses reported by the U.S. Centers for Disease Control last summer.
Those symptoms include shortness of breath, difficulty breathing, a cough and a hazy pattern noted on a chest X-ray — along with a history of vaping.
Across Canada there have been four confirmed cases and seven probable cases reported.
So far there have been no cases reported in Alberta.
But some physicians, including Edmonton-based lung specialist Dr. Dilini Vethanayagam, have reported other types of respiratory problems and adverse effects they believe to be related to vaping to their local public health office.
The province is aware of 11 such cases, but couldn't comment on the details nor whether Amber's pneumothorax is one of them.
"So are there other disorders that are coming out of vaping? Absolutely," said Vethanayagam.
Vethanayagam believes a pneumothorax could be caused by vaping if the sucking action was strong enough, similar to the way one inhales smoking cannabis.
"The pressure factor is important for pneumothoraces," said Vethanayagam.
A wake-up call
Amber said when she vaped it wasn't a deep inhalation, but rather short successive puffs.
Whether it was the smoking, the vaping, or both, that put her at greater risk for a pneumothorax, she said wants to make others aware of the potential health problems associated with either.
"I think this needed to happen to me in order for me to truly understand I can't do this, like I can't, or I could die.
"Like if it had gone on any longer, who knows what would have happened."
She said she's determined to quit and is thankful to have her family supporting her. Doctors told her if she didn't quit, there was a 30 to 50 per cent chance she would have another pneumthorax on the same side.
Tara Noland hopes Amber's story can help others.
"You hope that somebody will see her story and pictures you know, because we put them out onto Facebook, and they were quite graphic," Tara Noland said. "That you know, maybe they will sit up and take notice."
Amber doesn't believe an outright ban on vaping products would work but said limiting the levels of nicotine being sold and scrapping flavours targeting kids would help curb the uptake of vaping.
Vethanayagam would also like to see the province implement an aggressive education campaign.
"Public education has been minimal from a government standpoint … the only reason the rates are so high is because a lot kids are thinking this is safe, because the only marketing that's out there is from the company," said Vethanayagam.
The Alberta government is currently reviewing the province's Tobacco and Smoking Reduction Act with the aim of regulating vaping in the province.
The government expects to table vaping-related legislation next spring.