Walking through hell day 2 -With or without you

Yesterday I ran 2.2kms on the treadmill in 15 minutes, spent another 15 minutes on the cycling machine and used the elliptical machine for 7.5 mins. I was well short of my target but honestly by the time I got off the elliptical machine I was broken in every sense of the word. I slept like a baby for 11 hours straight yesterday and today when I woke up I had cramps in both my legs and every single part of my body felt sore. My mind on the other hand feels GREAT, it is probably because of the endorphins flooding my system right now.

My workout music nowadays is just based on one song: u2's with or without you (you're always in my thoughts Milena...can't help it lol🙃)


Now that I've addressed the play part, I wanted to talk about the Study part. 

Yesterday I watched about half of the pulmonology lectures, and right now I have an irresistible urge to 🤮 all that I've learnt so far. P.S: imagine if someone else discovers this blog and it ends up becoming a step 2 ck learning resource lol.

Ok so I am gonna start my 🤮 session by talking about some very basic stuff

LUNG VOLUMES:

The following diagram is something that I am pretty sure every medical student must've seen well over a billion times during their physiology/pathology classes, nevertheless this diagram is the key to understanding respiratory medicine and therefore a quick review is warranted.

 


Basic Definitions:

  • Tidal Volume= It's the volume of air inspired and expired on quite breathing at rest
  • Inspiratory Reserve Volume= It's the maximum volume of air that can be inspired over and above the tidal volume
  • Expiratory Reserve Volume= It's the maximum volume of air that can be expired beyond the tidal volume
  • Residual Volume= Air that can't be expired out of the lungs despite maximum effort
  • Forced Expiratory Volume in 1 sec (FEV1)= Maximum amount of air that can be breathed out in  one second
  • Inspiratory Capacity=  TV+IRV
  • Vital Capacity= IRV+TV+ERV
  • Functional Residual Capacity= ERV+RV
  • Total Lung Capacity = RV+ERV+TV+IRV
Learning this crap is the bane of my exsistence but trust me it is, as we shall see, fundamental to understanding the pathology behind a lot of respiratory diseases.

OBSTRUCTIVE VS RESTRICTIVE LUNG DISEASES

I am not going to bore you with the technical definition/details of what an obstructive or a restrictive lung disease is, you can look that up in textbooks yourself, instead my focus in this blog would be on the bigger picture.

An obstructive lung disease, simply put, refers to diseases that prevent air from LEAVING the lungs whereas restrictive lung diseases are those that prevent air from ENTERING the lungs. This in a nutshell is all there is to it. If you understand this you should have absolutely no problems understanding the graphs below.

Spirometry

The distinction between obstructive and restrictive lung diseases is based upon spirometric assessments. Although there are many requisites to a valid spirometric test, the two everyone should be aware of are:

  1.  There should be a peak in the flow curve
  2. Expiratory duration must be more than 6 seconds

 

Shown above is what a normal healthy spirogram looks like. It has a sharp rise at the beginning signifying the peak in the flow curve; the FEV1/FVC ratio is at approximately 80% and the shape of the overall curve is normal (i.e. tapering exponential).

Shown below is what a spirogram in someone with an obstructive lung disease looks like. As you can see there's a marked decrease in both the FEV1 and the FVC, and the subsequent FEV1/FVC ratio is decreased; this is a HALLMARK of Obstructive lung diseases. 
 
Hallmarks of Obstructive Lung Disease:
  1. The FEV1/FVC ratio Decreases
  2. All of the other lung capacities Increase
The spirogram of someone with a restrictive lung disease is shown below.


As you can there's a decrease in the FEV1 and the FVC as compared to normal; however the decrease in both these volumes is proportional, unlike in obstructive lung diseases where there's a far greater decrease in the FEV1 as compared to the FVC, and so therefore the FEV1/FVC ratio in restrictive lung diseases remains NORMAL (i.e. >80%), this is a hallmark of restrictive lung diseases.

Hallmarks of Restrictive Lung Diseases:
  1. The FEV1/FVC ratio is normal
  2. All other lung capacities decrease

Now let's talk about another way of viewing these changes on a graph, the flow volume loops.

FLOW VOLUME LOOPS

 I can't quite explain this without the help of diagrams and since I can't be bothered to make those diagrams here's a YouTube video explaining all there's to know about these flow volume loops. 




Now that we've got all the graphs out of the way, Let's talk about what I think is the single most sexiest pulmonary function test the DLCO.

DLCO

Restrictive lung diseases are caused either by:

  1. Poor Respiratory mechanics
  2. Interstitial Lung disease
What the DLCO test does is that it distinguishes between the two aforementioned etiologies of restrictive lung disease. The basic principle of the test is to make a person inhale small quantities of Carbon monoxide and to measure their blood levels of CO against a set of predicted values. If the blood levels fall between 75%-140% of the predicted values then the problem is with the respiratory mechanics and not with the lung parenchyma itself whereas if the levels are less than 40% of the predicted it indicates severe disease and a problem with the lung parenchyma itself.

Here's a list of low DLCO conditions:

  • Interstitial Lung Disease
  • Emphysema
  • Abnormal Vasculature:
  1. Pulmonary HTN
  2. Pulmonary Embolism
  • Prior Lung resection
  • Anemia
Ok people so my urge to 🤮 all that I know has now subsided...I am also kind of bored lol and so now for the rest of this blog I am going to be posting the music that I've been listening to lately (I hope you'd like it, Milena lol).

After the fact
Sensitivity builds a prison
In the final act
We lose direction
No stone unturned
No tears to damn you
When jealousy burns
Cold, cold heart
Hard done by you 


Comme si j'n'existais pas
Elle est passee a cote de moi
Sans un regard, Reine de Sabbat
J'ai dit, Aicha, prends, tout est pour toi

(ah this song brings back so many memories back from when I was in Libya..damn I still remember a lot of French from back then lol)


Je trouverai des langages pour chanter tes louanges.
Je ferai nos bagages pour d’infinies vendanges.
Les formules magiques des marabouts d’Afrique,
j’les dirai sans remords pour que tu m’aimes encore

Ajab
Sa Hai
Meray Tumharay Beech
Kabhi Kuch Hai
Kabhi Nahi





lt is beautiful isn't it?

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