TWS - Internal Medicine, Hypertension, and Water Magic

📝 Rx

Hi friends,

Recently started internal medicine and have been working with our resident team for the last week. I like that in IM you are in a really central role for patients, meaning you coordinate treatment for them with all of the other specialist doctors and have the most holistic view of their care. Being pretty general with treatment though means you have to know a little of everything which makes it pretty challenging, especially for me since I'm still very much learning everyday. On the bright side, it makes it easy to see where my weakness in content are since so many things come up. I've got 4 more weeks of this until I hit neurology so hopefully by the end I'm a lot more comfortable with general patient management.

🩻 Diagnosis of the Week:

Hypertension (famously abbreviated as "HTN" in doc notes)

What is it: High blood pressure (pretty self explanatory lol), but what's actually happening is a bit more interesting.

Imagine a tall apartment building with 30 floors and a single pump at the bottom pushing water up through the pipes. Getting water to the first floor is easy, the issue is making sure it gets to the 30th floor with gravity fighting us all the way up. There needs to be enough pressure so the entire building gets water.

If the pressure is too low, people on the 30th floor will definitely notice because they won’t have water. But what happens if the pressure is too high? Would anyone notice?

Not really.

If there is high pressure, the pipes (arteries) won't complain, they're just pipes. The people (organs) on the other hand won't notice there's an issue, they're happy as long as they have water (blood). The pump (heart) will just keep going, it's designed to work for years non-stop.

The high pressure is not good though, it speeds up wear and tear on everything until something gives. One of three things happens:

• The pump finally taps out, it's can't work so hard for so long -> heart problems
• The pipes become damaged and start to form leaks -> vessel problems
• The apartment shower pressure is the same as being attacked by a fire hydrant and people get hurt -> organ damage

This is why hypertension is "the silent killer." Nobody notices the damage it does until something finally gives out.

Key signs:

• 99%* of time completely asymptomatic - meaning you feel completely normal so people tend to be surprised when docs tell them they have HTN, this is why we constantly check blood pressure #silentkiller
  • *totally made up percentage but drives my point across
• General symptoms:
  • Headaches
  • Chest pain
  • Dizziness
  • Anxiety/stress feeling
  • Fatigue

🤓 Dose of the Week

✨Water Magic✨

Had Hurricane Francine come through this week. Thankfully pretty uneventful on my end, lost power for like a second and found out my windows are a bit leaky but that was it.

Interesting bit is my apartment is pretty high up and I noticed a bunch of rain droplets floating in mid-air for a few seconds which really threw me off. Thought it was really cool, did some googling to make sure I wasn't going cray. Apparently this is the result of super strong winds hitting the side of my building, being diverted upwards, then causing an updraft which cancels out the force of gravity on the rain for a few seconds. Sounds obvious, but pretty surprised it's the first time I've noticed this considering I've been living in high apartments for 3 years now 😶‍🌫️

I was really hoping this had some cool name like "the suspension phenomenon" or "hovering rain effect" but no luck so I'm taking charge and naming it the Raingardium Leviosa Effect™.