Huffing

Huffing

Whatever job I take, my husband says I basically function as a teacher.  There probably is some truth in this, and I seem to be forever reminding people that the verb “doceo,” the Latin verb “to teach,” is the word that the English language word “doctor” comes from.

Most of us doctors have little time for the teaching function.  This is not exactly what insurance pays for.  The internet is an explosion of information that absolutely dwarfs the ancient library at Alexandria.  Although I wish more people would be more aggressive about finding and using that information, I understand there is so much information that people don’t know who to believe.

That is the place where people should bombard their doctors with information they want clarified.

Even aggressive information seeking (what we now call “googling” as a generic term for searching on the internet) would not have saved the young lady who died  in Los Angeles from inhalant abuse – commonly called “huffing.”

I heard recently from a patient about the huffing practice being alive and well and I hit the ceiling, thus precipitating this article.  People die dead — young and previously healthy people –and they can die after even their very first attempt at huffing.

The substances abused are absolutely not controlled and have no warning labels that I have ever seen or heard of.

Last time I looked up stats on this practice, the average starting age was about age 12.

If I am very much a teacher when I am being a doctor, I am also being a doctor when I am a teacher.

Flashback to 1981 and I was with my parents and brother of blessed memory, having just finished my thesis defense in France (where the M.D. is a thesis degree) and I was waiting for the seemingly endless documents and legal hurdles that were necessary to continue my stateside practice and training.

I wanted to make some money to defray costs back at the family homestead, but had no medical license in the states yet.  I became a substitute schoolteacher and got a couple of long term jobs at a high school in suburban Boston.  One was teaching English as a second language. Later, I became a 9th grade algebra teacher.

I was actually invited to stay permanently after the principal observed me getting a roomful of young thugs to stand and do a dance I devised and named the “Everybody factor” dance.  They were more interested in dancing than math, and it was a tricky way to get them to learn a pretty decent job of factoring quadratic equations.

I had to pass up this offer, telling the principal I was just a physician awaiting credentialing and teaching was a “stop along the way.”  He shook his head in disappointment and wished me well.

He was no help when I reported to him that one of my algebra students had a job at the ice cream joint down the street and was passing out allegedly “empty” spray bottles of whipped cream topping to the other students who were enjoying sniffing them quite a bit.

They were sniffing freon.

Turns out that sniffing freon (or other refrigerants) can cause sudden death, usually by heart arrhythmia, sometimes by suffocation.  I told the principal who never, despite my entreaties, made any communications to the student body as far as I know, but I personally begged my algebra students not to do this, and to tell their friends not to do this, because they could die dead.

Yes, I said “die dead.”  You will notice how emphatic I am about people risking or losing their lives.  I had to actually tell them that this was the same kind of death that gets people to cemeteries.  This concept is not a reality to youth.  After all — lest any of us adults forget —  adolescents feel they are invulnerable.

This was a problem, to be sure, but it is only a pale shadow when we start talk about huffing.

This is hard-core inhalant abuse.

The first time I saw a “classical” case of huffing I was training in something I dearly love — the psychiatry of medically ill patients — one of those “cracks” that people slip through, created by excessive specialization has created.  This blurred space between medical and psychiatric illness — as well as the prejudice against those labeled and stigmatized with psychiatric illness — has shortened many a life.

Mentally ill people die (on average) 25 years younger than non-mentally ill people.  Nobody takes their chest pains or ulcers or other medical problems seriously.

I remember my patient in the intensive care unit of a midwestern hospital and he was 18 years old and very unconscious, comatose, getting oxygen through a tube.  He was in severe and terminal liver failure because he had been inhaling toluene, a common solvent he located in his mom’s nail polish remover.  Once this had been discovered psychiatry had been contacted, but there was obviously nothing we could do, except if and when he came to, make sure he knew not to do it again.

In the weeks I worked on the consultation service in that hospital, he never regained consciousness.  I do not think he ever did.  Our only function was trying to comfort his parents, who were understandably emotional basket-cases from guilt.  They had not known or recognized what was going on and we tried to get them so they did not blame themselves, for in most cases, nobody knows or recognizes what is going on with this one.

Small comfort when your child is dying.

Potential substances of abuse include all kinds of volatile solvents.  Aerosols.  “airplane glue.” Paints — watch for silver and gold and any other metallic paints that contain higher amounts of toluene.

The most frequent way to abuse is to inhale and put a plastic bag over the head.

This alone can suffocate people from lack of oxygen.

It is not just the chronic abusers who eventually die — death is possible with a first abuse from a constellation of causes.

Signs of chronic abuse are few — redness, maybe a rash around the mouth and nose, maybe no signs at all.  Maybe a little of the metallic paint stains around the nose or lips.

If death is not scary enough try this one:  Nervous system damage.

This can range from nerve deafness to memory problems to a virtual inability to learn or assimilate new material.

Most inhalants are wildly addictive – and are dangerously available everywhere.

One of the most common and most available today is in hand sanitizer.  You see either pump bottles or wet-towelettes everywhere now, in schools and supermarkets.

I can only wonder if the ubiquitous presence of hand sanitizer is one reason this sort of addiction may be on the increase.

In Los Angeles, where it seems to me like lots of folks are walking on the wild side, eating hand sanitizer has been reported to lead to what sounds like deaths from alcohol poisoning.

Inhalant deaths are maybe a few hundred a year in our nation, but they are wildly under-reported so who knows the real statistics?

Some suggest parents should teach children about the dangers of common household products, systematically.

Oy!  Like there is not enough to remember to teach children.

FDA?  Nobody is going to put warning labels on products of so many industries that flourish in the American capitalistic system.  The campaign contributions would dry up and lobbyists would pour money into campaigns against such labels.

Government warnings or sanctions?  Government, science and medicine have been confused in so many ways — good luck with your congress human on this one.

We have to rely on ourselves as parents, teachers or just concerned citizens, like these people seem to be the most serious of anyone who even mentions trying to prevent inhalant abuse.

When I was young, my parents would read about the Big Bad Wolf who would huff and puff and blow the house down.

I think today’s huffing is even more dangerous than that Big Bad Wolf.

Let’s do everything we can to keep him away from youth – and adults – that won’t survive an encounter with huffing.