TWS - Suburban Medicine, COPD, and Defaulting to Action

📝 Rx

Hi friends,

This week I've been away at a satellite hospital far from our main campus. It's definitely a different culture out here, people just know each other better since it's a smaller location.

As a med student it's nice to go on these rotations because there tends to be more opportunity to be involved in caring for patients, there's just less staff involved. You also tend to see less intense cases overall because anything serious or weird tends to be transferred over to main hospital.

Being in the main hospital is nice because it's very fancy and we have all the latest tech and treatment options, but coming from a student level I'd argue it can be a bit distracting from what's most essential in terms of medical management.

The hidden benefit of not being in a fancy center is you get a lot of the common conditions that are super important to recognize as opposed to more niche stuff. This, on top of having to make do with what you have is an excellent learning experience.

(We also get free breakfast and lunch here...huge plus 👍)

🩻 Diagnosis of the Week:

Chronic Obstructive Pulmonary Disease (COPD)

What is it: In general, a condition where people have trouble breathing air out.

If you can't blow out well, but keep breathing air in, the result is very inflated lungs. This makes it hard to breathe both in and out.

What's the issue with breathing air out?

So "COPD" is actually a spectrum between two different but very similar conditions that tend to be present together. Not gonna get into the weeds here but these two are why air gets stuck inside:

• 🤧 Chronic Bronchitis:
  • Think about the last time you had a really snotty nose and how you were probably breathing slower than normal, making funny whistling noises. If you tried to breathe out quickly, the snot always got clogged up and blocked the air coming out right?
  • Same logic in Chronic Bronchitis but it's happening inside the tubes of your lungs and it doesn't go away. If these people do not breathe out slowly, the mucous clogs their lungs and stops air coming out properly, causing their lungs to become filled with air.
• 🎈Emphysema:
  • If you've ever tried to inflate a water balloon, this one's easy. After inflating a water balloon, if you let it go, it will immediately deflate and go back to normal. This is just like little structures in our lungs called alveoli. The recoil from these alveoli pushes air back out in the same way a water balloon deflates.
  • In emphysema, the alveoli get damaged and destroyed to the point where they do not recoil and deflate very well. They become all floppy, so now it's more like blowing up a big pool toy instead of a water balloon. When you release, the pool toy air comes out slowly with a lot staying in. Same thing in emphysema, making air get stuck in the lungs.

Either way, the more air stuck inside the lungs, the less new air we can breathe in and the less oxygen our body gets.

Key signs:

• Shortness of breath that gradually gets worse over time
• Chronic cough with mucous (can be clear, or not)
• Slow breathing with pursed lips (helps air move and we sometimes do it subconsciously)
• "Barrel chest" - chest looks inflated because your lungs are full of air they can't push out

🤓 Dose of the Week

When overthinking, default to action.

Sitting and repeating scenarios over and over again in your head won't fix the problem. You'll feel worse as you watch time go by with nothing to show for it.

Just do the thing. It's all theoretical until you take the first step anyways.

Have a solid week,

-Frank