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As vaping related illnesses, deaths continue to climb, local experts urge families to "take it seriously"

A few years ago, a routine question to a teen patient would be, “Do you smoke?”

Now, says Dr. Todd Mahr, a pediatric allergist at Gundersen Health System, his query has changed.

“You have to ask ... are you vaping, juuling or inhaling anything?” Mahr says. “Teens are always trying to jump on the newest thing. (Vaping devices) aren’t made to look like cigarettes so kids don’t think of them as cigarettes.”


Indeed, as use of conventional tobacco products continues to decline, vaping usage has skyrocketed, particularly in the teen sector, as health professionals and organizations scramble to keep up with an influx of related illnesses and fatalities.

In an effort to address what is being considered a national crisis, the La Crosse Area Health Initiative is hosting a screening of the locally produced educational video “Know More About Vaping” during a community event from 3 to 4:30 p.m. Thursday at the Myrick Park Center.

The short film, featuring area health experts along with parent and youth perspectives on the topic, will be shown at 3:15 p.m., followed by a recognition of local smoke-free environment advocates Jay Odegaard, Fawn King and Leah Burns. A “Taking Action In our Community” program will begin at 4 p.m.


The film, produced with the help of UW-L student Kate Ottow and featuring local teens, parents and Dr. Peter Polewski of Gundersen Health System, is targeted at adults and touches on the health impact, level of exposure and facets of vaping.

“It gives validity to parents that it is real, it’s happening and we need to take it seriously,” says Judi Zabel, health educator with the La Crosse County Health Department.

As of Oct. 29, the Center for Disease Control had received 1,888 reports of e-cigarette or vaping product use associated lung injury (EVALI), with cases from every state except Alaska. Additionally, 37 EVALI deaths occurring in 24 states have been confirmed.

Wisconsin has not yet reported an EVALI related death, but the Wisconsin Department of Health Services as of Oct. 24 has 78 confirmed and probable cases of vaping-related severe lung disease with an additional 18 patients under investigation. La Crosse is among the counties with cases, and while Mahr has not yet seen any patients with a vaping-related illness, he notes some with prior respiratory conditions have had their symptoms exacerbated by vaping.

The CDC, which updates the data weekly, says that THC is linked to most of the EVALI cases and plays “a major role in the outbreak.”

Likewise, the Wisconsin Department of Health says that of 27 cases evaluated as of late August, 89% involved vaping of THC products such as waxes or oils.

The CDC, however, notes no single compound or ingredient has yet been cited as the cause of illness, with numerous substances and product sources being investigated.

Says the CDC website, “The specific chemical exposure(s) causing lung injuries associated with e-cigarette product use, or vaping, remains unknown at this time.”

“THC is definitely part of it, but not (everyone) is using THC products” in their devices, says Mahr. Also of great concern to him are the extreme high temperatures vaped oils can reach, the lack of ingredient and label regulations, prevalence of “knock-off” and black market devices and manufacturing of vaping concealing apparel, such as hoodies that allow for discreet inhaling.

“It’s exploded into the wild, wild west of products and nobody knows what’s going on,” says Mahr, who takes issue with both the manufacturers of vaping devices and the Food and Drug Administration, which he bluntly says “put its head in the sand.”

The FDA has conceded as much. In September, Ned Sharpless, the FDA’s acting commissioner, said of the delay in enforcing regulations on vaping products, “In retrospect, the agency should have acted sooner. ... We’re going to catch up.”

Regulation deadlines were extended in large part due to the hopes vaping would serve as a smoking cessation method, or at least a safer alternative. Mahr says a year ago he might have said that if you refuse to quit smoking, vaping was “probably a better alternative.” However, today he “would say no, vaping is not a safe alternative.”

Zabel, who notes “it would have been nice and easier” if vaping regulations had been put in place at a federal level, says it is possible — and crucial — to do so at a state level, which requires cooperation and education.

And parents, mentors and teachers have the added responsibility of broaching the risks at a much younger age than most are doing so — ideally by third grade, Zabel says.

“Too often we wait until they are teens,” Zabel says. “We need to be having these conversations much earlier than we do and more often.”

As of Oct. 15, the median age of an EVALI patient was 24, with 14% of patients under age 18. And according to the Wisconsin Department of Health Services 2018 Youth Tobacco Survey, even preteens have tried vaping, with 96% of those who have ever used an e-cigarette doing so before age 13. One in nine middle schoolers statewide said they had tried an e-cigarette, as had one in five high schoolers.

From 2014 to 2018, e-cigarette usage among Wisconsin middle schoolers increased 272%, and among high schoolers vaping increased 154%. Notably, 95% and 89%, respectively, would not use unflavored tobacco products.

Indeed, it is flavorings like bubble gum, creme brulee and strawberry kiwi that reveal the nefarious intentions of vaping manufacturers, many health professionals say. Mahr says companies clearly aren’t targeting adults with candy-inspired cartridges, and when something is appealingly flavored it inspires increased consumption, manifesting into addiction.

“There are over 15,000 flavors,” Zabel notes. “These are attractive to young people. Kids think these are regulated and I’m always embarrassed to say we haven’t done that with e-cigarettes. They’re not locked up and they’re out on the counter. But just because it’s easy and accessible doesn’t mean it’s safe. There is no such thing as a safe tobacco product.”

While some states have banned e-cigarettes in an effort to address the problem, Mahr says that is not a viable solution as it fails to address the addiction. Though the number of youth statewide who smoke traditional cigarettes is down to 5%, that number will begin to climb again if the e-cigarette alternative is criminalized, creating a vicious cycle.

Like Zabel, Mahr encourages parents to have conversations with their kids about vaping. He eschews scare-tactics but says age-appropriate, fact-based talks are instrumental in getting through at an age when many are easily swayed by advertising, peer pressure and the novelty factor of sleek gadgets.

“Kids think they’re invincible and and they think it’s cool,” Mahr says. “They think it’s just vapor and there’s nothing wrong with it. But we don’t yet know how permanent or how problematic these (health effects) will be.”


Number of long-term care patients increasing in La Crosse County, while number of CNAs on the decline
Peter Thomson, La Crosse Tribune 

Jennie Maas, a registered nurse at Hillview Care Center, listens to the heartbeat of resident Paul Finner. Mass, a 23-year veteran in the industry, started her career as a certified nursing assistant.

In 2018, La Crosse County paid $653,548 total in overtime to Hillview and Lakeview employees, according to data provided by the county.

Of that, $554,961 in overtime was paid to employees with “nurse” in their title; $274,643 in overtime was paid to certified nursing assistants, specifically.

Regardless of the voluntary overtime allotted, about a dozen nursing shifts remain unfilled per day in county-run facilities, said Wanda Plachecki, executive director of long-term care and residential services in La Crosse County.

The staffing problem isn’t unique to La Crosse, or its long-term care facilities. Employers all over the state are struggling to keep positions filled due to a workforce shortage.


The shortage is the result of a combination of problems such as significantly low statewide unemployment and shifting demographics — the state’s population is aging, more people are predicted to enter into retirement and fewer people are predicted to enter into the workforce to replace those exiting the workforce, said Steve O’Malley, La Crosse County administrator.

Employers are unable to find qualified people to work in large numbers of positions across Wisconsin, especially in long-term care, he said.

“The issue is compounded in lower-paid positions, such as an industry like long-term care where Medicaid and Medicare from the federal government don’t adequately pay for (the) full cost of operating a large-scale nursing facility or assisted living,” O’Malley said.

In 2018, more than 90,400 Wisconsin residents lived in long-term and residential care facilities, a 23% increase over the past 15 years, according to a report on the long-term care crisis by the Wisconsin Health Care Association.

Regardless of that increase, there was a 27.1% decline in the number of first time registrants to the Wisconsin Nurse Aide Registry between 2012 and 2018, and despite that decline, the need for personal care workers is predicted to increase 26.4% by 2022.

The aging population projected for the next few decades not only means there will be fewer people in the workforce, but also there could be more individuals who need more services and specialized care, O’Malley said.

In the next 12 years, the number of Wisconsin residents age 65 and older is projected to reach more than 1.5 million, according to a study conducted by the University of Wisconsin-Madison Applied Population Laboratory.

Peter Thomson, La Crosse Tribune 

Certified Nursing Assistant Olivia Cracker, currently studying at Viterbo University to become a registered nurse, makes a resident’s bed at Hillview Health Center. About a dozen shifts per day go unfilled at the long term care facility due to a local shortage of CNAs in the job market.

O’Malley also pointed to the pay scale for certified nursing assistants in the area as another reason for the staffing problem, as it’s more difficult to fill positions that pay between $13 an hour and $17 an hour than higher paid professional positions, O’Malley said.

If a person enters the workforce as a certified nursing assistant, it’s only a matter of time before they move on to a higher nursing position or leave the medical field for another higher-paying profession. According to the Wisconsin Health Care Association study, 67% of long-term care providers said personal caregivers left for jobs outside of health care in 2018.

La Crosse County long-term care facilities are significantly understaffed, with nearly a dozen shifts per day that go unfilled. Often, staff will work overtime to cover gaps in shifts, but overtime is not mandated for certified nursing assistants.

“It’s going to be a challenge not just in La Crosse but statewide and nationally,” O’Malley said. “Especially when the federal and state governments have not stepped up to deal with the inadequacy of Medicaid and Medicare funding for providing services.”

And the problem could affect those who aren’t on government-subsidized medical programs at the start of their care.

If a person enters long-term care with the assets to pay for private care, they’re paying for medical services at a higher rate. If they deplete those resources and enter a county-run facility, they rely on government programs like Medicaid and Medicare, which don’t pay for the full cost of care, O’Malley said.

The Hillview and Lakeview long-term care campuses have a higher-than-average number of residents who rely on medical assistance programs, low-income residents who require specialized care and residents who have left other facilities due to behavioral problems, Plachecki said.

Peter Thomson, La Crosse Tribune 

Nate Kalmes, a certified nursing assistant at Hillview Health Care Center, takes resident June Holy to an exercise area. La Crosse's elderly population is growing but there is a lack of staff to care for the current number of residents in county run nursing homes.

“County homes generally have a higher percentage of residents who are on Medicaid,” she said.

But, because government-subsidized medical assistance programs don’t usually pay for the full cost of care for a resident, the facility is required to use other pay sources to cover the cost of care. And due to the lower rate of medical reimbursement, the county-run facilities are unable to pay employees a competitive wage.

“I see a group of CNAs that are getting close to retirement, have made this their career, and they’re going to be leaving us” in the next five years Plachecki said. “I don’t know how we’ll replace them because we’re not finding people who are interested in caregiving as a career” due to low wages.

Plachecki said she is watching with trepidation as the number of residents who need long-term care increase, but the number of people willing to work as a care provider decrease. Hillview Health Center has 137 licensed beds in its long-term care facility but not enough employees to care for that many patients.

“We could never fill all of those beds today because we wouldn’t have the staff available to provide the care,” she said.

Currently, 40% of the staff at Hillview are direct caregivers and 58% of our staff at Lakeview are direct caregivers. Between the two campuses, they have about 200 direct caregivers.


Not every county operates a long-term care facility,. In fact, it’s increasingly unusual that a county operates a long-term care facility, said Tara Johnson, La Crosse County Board chair.

La Crosse County regularly analyzes the pros and cons and cost of running long-term care facilities. And, according to the analysis, if the county-run facilities don’t exist, the county could spend more money to send people who reside in La Crosse County to facilities in other parts of the state.

“Then, their outcomes aren’t as good because you take people away from their community of support,” Johnson said. “We have continued to make the commitment to operating Hillview and Lakeview, and that places us in competition with other nursing home providers.”

The county is trying to maintain a high-quality workforce in a competitive environment, but it is not used to increasing worker pay to meet private-sector market demands and attract the candidates needed to fill open roles. However, that could change.

The La Crosse County Board Executive Committee passed a resolution to increase pay for certified nursing assistants who are employed at county-run nursing facilities in October, and the vote is scheduled to go before the board in November.

“That’s unusual for us because we are treating this group of employees ‘differently’ (than other county workers) because we have to maintain that workforce,” Johnson said.

If approved, the new pay rate for non-licensed positions — including certified nursing assistants — will go into effect Nov. 25 and will provide a raise of 2-3% for current employees. The county board will also consider a 1.75% pay increase for all staff, starting Jan. 1, O’Malley said in an email.

“We believe the new ranges will be more attractive when hiring new staff and help us to retain current employees,” he said.

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Let us know how charitable you plan to be this season

The La Crosse Tribune and La Crosse Community Foundation are partnering to see how La Crosse County residents compare with the nation when it comes to holiday giving as it relates to local charities.

To measure the comparison, we’re asking La Crosse County residents to participate in a short poll between now and Nov. 24. The poll has only three to seven questions and should take less than two minutes to complete. All responses are anonymous; we’re looking only at the collective response.

To participate, visit lacrossetribune.com or simply scan this QR code with your smartphone to go immediately to the survey.

Results will be published in the Dec. 1 edition of the La Crosse Tribune.