What have we learned after 100 episodes?
How time flies! On June 3rd, 2020, when the world was still in lockdown, we released our very first episode on the pathophysiology of fingernail clubbing. More than four years and dozens of shows later, we thought we’d celebrate the podcast with a special 100th episode. Here are some of the episodes that we’ve especially loved doing and hope that, if you haven’t heard them before, will give a listen to!
- Episode 18 addresses a classic Curious Clinicians question: Why is thirst quenched so quickly? Thirst is a mechanism that can be produced by ADH or angiotensin II in response to changes in circulating volume and/or blood osmolality. However, the 10 or so minutes it takes a drink for water to be absorbed in the bloodstream is far more than the time it takes for that water to quench your thirst. Tony walked us through how this works: There are areas of the brain, such as the SFO and OVLT, which are activated by the act of drinking water and can preemptively reduce thirst.
- Episode 23, where Hannah introduced us to a marvelous piece of medical jargon: “Bendopnea,” or shortness of breath within 30 seconds of bending over. We were surprised to learn that it comes from elevated left ventricular filling pressures, and therefore can be used to assess heart failure severity.
- On the subject of heart failure, we loved episode 25, in which Avi asks why furosemide can improve pulmonary edema secondary to heart failure almost immediately. Some patients even feel better before they’ve urinated! Again, it has to do with the left ventricle – furosemide is not only a diuretic, but also causes venous dilation through inhibition of prostaglandin breakdown. The reduced venous return to the heart helps lower left ventricular filling pressures.
- Everyone learns the term “Cheyne-Stokes breathing” in medical school, but how many of us can actually define what it is, let alone what causes it? In episode 34, Avi walked us through how severe heart failure can cause this distinctive cycle of alternating periods of deep, fast breathing and apnea. In short, many heart failure patients have baseline hyPOcapnea (from chronic lung congestion), which causes them to have compensatory apnea (to retain CO2), but because of sluggish and delayed circulation in the CNS, respiratory control centers don’t see blood until it’s relatively hyPERcapnic, which then sets off a compensatory tachypnea.
- A question from Tony’s daughter inspired episode 87: Why do her fingers wrinkle after a bath? The pathophysiology of “aquagenic wrinkling) is actually quite simple: Neurogenic vasoconstriction of blood vessels, which are irregularly anchored to the skin, causes the characteristic prune-like wrinkles. We learned that there is not only a plausible evolutionary reason for this (the wrinkles may have helped our ancestors grip wet objects), but a clinical correlation (peripheral neuropathy can cause someone to lose their ability to wrinkle in water).
- And finally, we can’t not mention our resident hematologist-oncologist’s explanation in episode 89 for why elephants actually have lower rates of cancer than humans (and no, it has nothing to do with smoking). Hannah introduced us to “Peto’s Paradox,” a famous observation about how the larger and longer-living mammals are, and therefore the more cells and time for mutations to happen, the odds of cancer don’t actually go up, and can even decrease. Elephants have a whopping 20 copies of TP53, the most important tumor suppress gene, which protects them against any increased threat of cancer-causing cells.
Thank you all for listening to us! We hope to bring you 100 more episodes that ask “Why?”
Take Home Points
- If you’re curious to know the answer to a question, it’s highly likely others will be similarly interested.
- Medicine is hard, curiosity is easy.
- Clinical curiosity is a super power.
Listen to the episode!
Watch on YouTube!
CME/MOC
Click here to obtain AMA PRA Category 1 Credits™ (0.5 hours), Non-Physician Attendance (0.5 hours), or ABIM MOC Part 2 (0.5 hours).
As of January 1, 2024, VCU Health Continuing Education will charge a CME credit claim fee of $10.00 for new episodes. This credit claim fee will help to cover the costs of operational services, electronic reporting (if applicable), and real-time customer service support. Episodes prior to January 1, 2024, will remain free. Due to system constraints, VCU Health Continuing Education cannot offer subscription services at this time but hopes to do so in the future.
Credits & Suggested Citation
◾️Episode written by Avi Cooper, Tony Breu and Hannah Abrams
◾️Show notes written by Giancarlo Buonomo and Tony Breu
◾️Audio edited by Clair Morgan of nodderly.com
Cooper AZ,Abrams HR, Breu AC, Buonomo G. Episode 100. The Curious Clinicians Podcast. November 13th, 2024.
Image Credit: Adobe Stock
The Curious Clinicians 