Don't Fall Asleep - Pulm Block and Ondine's Curse

Summer is over, and I am back in Boston for Year 2 of medical school. ACK! Things aren't really all that different, but at the same time everything has changed. This week was orientation for the new (and adorable) first year students, and a big reality check for me - medical school is back and it is no joke.

Second year is about systems - we learn function and dysfunction in each system of the body. They started us off with pulmonary! We had 18 lectures this week, which I may have thought was nothing last year, but now seems impossible to keep up with. On top of lectures, I learned how to draw blood on a boy in our class with veins the size of my pinky finger, reunited with my classmates, and also tried to help with first year orientation. I attended numerous social events, forgot a lot of names, answered a lot of questions, acquired a first year mentee (and many unofficial mentees), co-hosted a potluck, and was captain of Team China for the First Year Tufts Med Orientation Olympics (see photo - I face painted my co-captain into a Panda).  Upside to all of these activities: lots of free food. Downside: I am sooooo tired!

Speaking of sleepiness, we learned about a crazy sleep related pulmonary disease that I think is share worthy. It's called Congenital Central Sleep Apnea, but is also known as:

 ONDINE'S CURSE.... dun dun dunnnnnnnn

The disease nickname comes from a German folk tale that goes like this:

Ondine was a water nymph that fell in love with a mortal human named Palemon. Knowing that falling in love with and bearing the child of a human would cause her to lose her eternal youthfulness, she weaseled Palemon away from his current fiance and married him. When they exchanged their wedding oaths, Palemon promised that every waking breath he takes would be a testament of his love for her. After having their son and losing her eternal youth, she caught Palemon naked and asleep next to his former fiance (once a cheater always a cheater...). To force him to keep his vow, she cursed him so that he would only be able to breathe while awake and able to remember to take each breath. Eventually, he fell asleep, stopped breathing, and died.

Patients with Congenital Central Sleep Apnea have abnormal autonomic control of breathing (abnormal breathing without thinking). During the day, they can consciously control their breathing, but at night when they depend on autonomic control, they experience periods of apnea (AKA they stop breathing altogether). Just like Palemon... but I don't think these patients ever cheated on water nymphs. Luckily, this is a rare genetic defect and there are only about 300 known cases of the disease, and severity varies. CCSA patients can live normal lives if they use a ventilator when they sleep.

There are lots of mechanisms that make your body breathe when you aren't thinking about it, or even when you try to hold your breath. Most importantly, chemical receptors check your blood for oxygen and carbon dioxide. When oxygen gets low (hypoxemia) or carbon dioxide gets high (hypercarbia), these receptors send messages to your brainstem to speed up and deepen your breathing. This system fails in CCSA patients.

So I may be sleepy from my first week back, but at least I won't stop breathing when I finally get to hit the hay!