Similarly, a study using a mouse model found that PNE produced hyperactivity that was associated with selective decreases in cingulate cortical volume and radial thickness and a decrease in drug-induced dopamine release in the frontal cortex [36]
With that also comes that small number of people who have been not so kind, who have gone out of their way to try to make me feel bad
Let me tell you something, Tristan-- and you too, Isolde, if you care to listen-- no pleasure on Earth is worth sacrificing for the sake of five extra years in the geriatric ward of the Sunset Old People's Hospital in Weston Supermare
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 Report, COPD is defined by post-bronchodilator spirometry showing a fixed ratio of FEV1/FVC 50 mmHg) Altered mental status (hypercarbia) Signs of Lower Respiratory Infection (J44.0 trigger) Fever, productive purulent cough, consolidation on CXR or CT chest Positive sputum culture, elevated WBC/CRP/procalcitonin Clinical diagnosis of pneumonia (J12J18) or acute bronchitis (J20.x) documented by provider Systemic / Advanced Disease Features Barrel chest (emphysema: hyperinflation, increased AP diameter) Prolonged expiratory phase, diminished breath sounds Clubbing (suggests comorbid bronchiectasis or malignancy not typical COPD alone) Peripheral edema, elevated JVP (cor pulmonale / right heart failure) Cachexia, weight loss (systemic inflammation) Cyanosis central (severe hypoxemia), peripheral Symptoms alone (dyspnea, wheezing, cough) should NOT be coded when COPD is established as the confirmed diagnosis
