COVID-19 Files: Ep. 3

All right, gut check fans and everybody at KBMD health. Thank you all for joining us again for a third installment of the COVID file. Dr. Brown and I are here to talk a little bit about the physiology and kind of how people actually get sick. And Dr. Brown actually asked me to do a little role reversal. So can you want to explain a little bit what's going on here?

Yeah, so this is COVID files number three, and we got a lot of feedback when Dr. Ackerman and I did 2.5 we're all we did is talk about the gastrointestinal stuff. Then everybody else is in the news is talking about respiration, pulmonary stuff. And so we got a lot of questions about that. And I just happen to see that like, a world renowned infectious disease doctor, Dr. Peter Hotez was on Joe Rogan. And Joe was asking all these lung questions in detail, so I realized that you know, you're an expert in this your training is a crna. This is right in your wheelhouse. So I thought that we could just do some of that. Even on some of these other shows, they're interviewing virality and they're interviewing epidemiologists and they go really, really into the science. What we know that calm is contagious. And we know that the more information you have that can actually calm you down. And that's what we're trying to do in this show. We're trying to get people through this crisis. But I do believe that if you understand the physiology, then it makes sense why some people can get really sick and it makes sense why some people get better. And so you being an expert in this is just perfect. And we're getting questions like this like from a Mike Logzen from Texas. Interesting. We have one of those working for us also. 

Yeah I know, names like that. Just keep popping up there's Mike Logzen one, Mike Logzen two I wonder if there's a Mike Logzen three.

I know, so Mr. Mike Logzen and asked what are your thoughts on why younger people and healthcare workers are getting hit hard as this disease goes on? That's a great question. And in fact very relevant. Newsweek just did an online publication that I received this morning, where it said the over 100 healthcare workers have died from COVID-19 So this is this is an important question. So really what we're going to do with you today is talk about the pulmonary physiology and what happens and when people say, oh, this can affect you, and you get this rapid progression that can be very frightening and different things like that. But just understanding what's going on, I think is the real important thing. So, I just want you to take it away. I'll interrupt. I'm hopefully not too much, because I have a tendency to do that. And if I am just gonna wait I got a slide on that. We'll get to that. So

A couple a couple of quick apologies that we learned in technology since we are all practicing social distancing and Dr. Brown or Ken is, is addressing his patients over in the Plano area I'm trying to help out over here in the in the Denton area. We actually are not together obviously, it's while we're recording like this, so I had to make some really bad drawing slides. Ken, you're gonna love these they are they're really, really artistic. And as I share them with you gonna pull our faces down from the screen. So bear with us, it's not normal. But we'll try to take some breaks in there, we've learned we can't put them all up at the same time at least we're not smart enough to do that. And Ken if I go too deep, if you feel like I'm losing votes just going back, hang with us though. The goal here is to show you how the disease itself is probably going to affect your lungs. And then to get to a point of showing you how we think we can work through it. I'm going to show you the tough parts, but at the same time, what it is that we're hoping to do to really get people through it. So that's

Really even if this is not relevant to you, I I do know where we're going to go with this. And right now, the mayor of New York City is thinking about bringing in a doctor draft where basically they're going to pull doctors out of retirement, they're going to ask doctors in different specialties to try and help out with these pulmonary issues. So you can even forward this to your doctor if you have family or friends that are in the healthcare field. This is something you could forward to them. Because if I happen to get called in, I want to be informed on how to treat people with their pulmonary situation, not just their gastrointestinal. So this this could also be very relevant for healthcare workers, our frontline people.

I agree, I agree. And I'm hoping that we can make some make some light of not necessarily light but bring some information that gives some people some comfort. So you'll see here my very first drawing right off the bat did not load the way I wanted it to. So that's a little bit of humor there. And that's about as good as these drawings are going to get. So I'm sorry, these are loans. That little green arrow is pointing up to a diaphragm, just a quick refresher, as a diaphragm contracts, it pulls down on the lungs, giving a negative pressure or pulling air into the lungs. And that's important when you're healthy. You're pulling air in, you're not necessarily having it pushed in some but what you need to recognize is that the lungs are made up of five different lobes the left lobe has two the right lobe has three and every single one of those lobes has tons, literally over 300 million alveoli per lung. So you a 70 kilogram average adult has around 600 million alveoli and that gives you tremendous surface area for oxygen and co2 exchange. That's what keeps us alive and that's what the oxygen keeps us alive in the co2, of course, is our waste gas that our body is pushing out. And if you were to spread it out flat, that equals to roughly a little bit larger than a tennis court, so Ken.

Wow, and so the analogy I always thought about this is a tree the main bronchus is the trunk, then you get split, and then it keeps going into smaller branches where the leaves could kind of represent the gas exchange or the alveoli. Do you visualize it like that?

Yeah, tree is exactly what they call it. It's a tracheobronchial tree and it runs all the way out. There's actually I believe, 23 generationss of tubes getting smaller and smaller and smaller until we get out to the alveolus itself. So alveoli is all of them. Alveolus is a singular one, don't hold me to it, I often interchange them myself while talking about them. So one particular alveolus. I've just drawn an arrow, it's in the lungs, it's everywhere. But I'm making an arrow and a draw here, because this is what we're really going to get started with on how it all functional I'm sorry, here's the heart. We'll we'll talk about this a little bit later in positioning but know that the heart lies anterior towards the front of your body a little bit, and a little bit over to the left. So but that's where the heart is located as it receives blood pushes it to the lungs receives the blood again and then pushes it out to your body. So let's look at that alveolus. The alveolus right here, you'll see inside the circle, that's actually the external air that we've just breathed in. So that's where our fresh air oxygen, oxygen rich air will come to, and it will be taken up by the capillary. The capillary is the blood supply that's bringing up the gas that needs to pick up oxygen and let go of excessive co2 carbon dioxide, that's the waste gas.

So that's the exchange, the oxygen goes in carbon dioxide goes into the little alveoli, then we breathe that out.

That's exactly right. And you'll notice, even though my drawings are poor, you'll notice you'll see the capillary here in a moment is going to start to kind of pull away in distance and that just makes it harder for that gas exchange. Inside the alveolus there are two specific cells that we have in there pneumocyte...