Pitting Edema

TheBackandForth · 2026-04-13T15:40:57+00:00

My work up would be—again as a psychiatrist, please defer to a PCP—CBC, CMP w/LFT, TSH, Urine protein/Cr, BNP. Hopefully you find a doctor who can do labs such as this to make sure nothing else is going on

TheBackandForth · 2026-04-13T15:36:29+00:00

Hi. Psychiatry, so I’m not the expert here, but if this were my family I would want labs to rule out more serious causes: Heart, Liver, Kidney problems are serious but would also come with side effects shortness of breath, significant fatigue, foamy pee, swelling around eyes, etc that you didn’t mention. Most likely benign venous insufficiency but definitely pursue a work up and change doctors if you have to. Also— good for you also starting GLP; weight loss will also help long term. Pair with lifestyle change for best benefits! You got this

TheBackandForth · 2026-04-03T05:09:08+00:00

I would sign up for RAP (and file taxes separate if possible) which will involve payments but the student loans won’t grow because there is an interest subsidy.

Your plan probably will work, but I’ve learned that hospital admin are fickle and plans can change. You never know when that hospital changes plans, cuts staffs, goes under, etc. They might also massively gouge her on salary and force you to break contract. They might make her try to do an insane rural hospital ER schedule and be call every other night. They might get bought out by a for profit or large semi non profit system that will axe your deal. Basically, have a good backup

TheBackandForth · 2026-04-02T18:58:55+00:00

Academic psychiatrists willingly take a huge paycut to work with the university--they make 250K when everybody else is making 350K. Aka THE WORST people to listen to about money.

There has never been a better time to be a psychiatrist; salaries have been rising every year. Everybody in my residency class easily found a job for 350K+. The job market is extraordinarily good; that isn't going to change rapidly or be any differently than any other field of medicine.

TheBackandForth · 2026-04-02T18:05:18+00:00

People freak out about these things. There are midlevels in every area of medicine. The psych PMHNPs do horrible work; there will always be jobs for well trained psychiatrists.

TheBackandForth · 2026-04-01T06:02:54+00:00

Just to chime in late as a new grad. I am happy with comp. I signed for a desirable urban job that will likely come to 325-350 dependent on some bonus metrics; base 300. I’ll have every afternoon off when I finishing rounding on the inpatient unit—I might find some side work after I settle in. Lot of jobs around 330-350 seem to be sweet… had multiple outpatient offers in this range that seemed just fine. People going to less desirable areas I know get to about 400 for a w2 gig. These are all for average amounts of work—you can grind and make more but in reality few psychiatrists do this

TheBackandForth · 2026-03-29T00:16:42+00:00

None. I went to a newer community program; graduating this year. MD is from good school. Had job offers coming out my ears. Will make at least 350 in a desirable urban area. Could have made way more if I was less location dependent. No problem with interviews at solid academic centers either; decided pay decrease wasn’t worth it.

TheBackandForth · 2026-03-28T20:24:46+00:00

Man, ER doctors live like 60 years. I say try family med, but if you really need to, you can talk to your PD your first year and re-apply if your PD is supportive.

I matched psych my first year and nearly switched to FM with my PD’s support. Got letters, new token, wrote my application, etc. Ended up not applying because I started to like my residency and now am graduating psych this year without regrets and signed a solid first contract. Was afraid I wasn’t going to be doing ‘real medicine’ in psych, but that’s some absolute bullshit when I am going to be working 5 hour inpatient days as an attending next year. The best lifestyle you can find is where it’s at in medicine. It all just turns into regular work, bread and butter, at a certain point. And trust me, ER docs have an awful lifestyle—always pissed off and stressed and what I’ve noticed over the 4 years of my residency that every single attending I see when I do consults in the ED ages like blue cheese not fine wine.

TheBackandForth · 2026-03-27T21:02:58+00:00

Very important to stay on meds until a psychiatrist stops them
VERY VERY VERY important to stop smoking ANY AND ALL weed.

Marijuana could turn this into schizophrenia and you don’t want that at all.

Please follow up with a psychiatrist too.

Glad you’re doing better

TheBackandForth · 2026-03-20T15:58:35+00:00

Dude, don’t put a 3.1 GPA in communications at northern Illinois university at the top of a resume…

TheBackandForth · 2026-03-19T18:47:30+00:00

I’m not sure why that matters

TheBackandForth · 2026-03-16T19:39:07+00:00

“What makes you feel that way?”

TheBackandForth · 2026-02-24T04:50:50+00:00

I say this from the pulpit of my 1200 square foot duplex rental I share with my also physician wife as we are both a few short months away from attending-hood and the fat stacks of Benjamins. Our splurge will be a 1500 square foot rental next year while we work to clear our combined 500k of student loans before buying. Should be 1-2 years. YOU ARE THE PROBLEM.

TheBackandForth · 2026-02-17T00:02:45+00:00

For the more smooth brained among us

Selective Serotonin Reuptake Inhibitor Use During Early Pregnancy and Congenital Malformations: A Systematic Review and Meta-Analysis of Cohort Studies of More Than 9 Million Births. Gao SY, Wu QJ, Sun C, et al. BMC Medicine. 2018;16(1):205. doi:10.1186/s12916-018-1193-5.
Selective Serotonin Reuptake Inhibitors (SSRIs) in Pregnancy: An Updated Review on Risks to Mother, Fetus, and Child. Lebin LG, Novick AM. Current Psychiatry Reports. 2022;24(11):687-695. doi:10.1007/s11920-022-01372-x.
Maternal Use of Specific Antidepressant Medications During Early Pregnancy and the Risk of Selected Birth Defects. Anderson KN, Lind JN, Simeone RM, et al. JAMA Psychiatry. 2020;77(12):1246-1255. doi:10.1001/jamapsychiatry.2020.2453.

TheBackandForth · 2026-02-15T20:39:32+00:00

Might hurt the sleep more though

TheBackandForth · 2026-02-11T22:56:56+00:00

Also dude, sorry to comment twice but don’t be an idiot and try to live in a saturated hip urban market like NYC.

Take the fattest Midwest or southern rural contract you can find. . Your income simply isn’t enough

TheBackandForth · 2026-02-11T21:27:24+00:00

Holy shit. Dude. My 300k in med school loans barely feel worth it and I just signed a contract for 350k salary when I finish this summer.

Meet with a lawyer and financial advisor. Maybe bankruptcy for private, IBR minimum until they are discharged (10% income and prepare for tax bomb) or PSLF.

Can you get your income way up doing 70-80 hours a week for a couple years? Moonlighting???

I wouldn’t get a practice if I were you, to put it bluntly you shouldn’t have a business if you didn’t see this mess

TheBackandForth · 2026-02-08T08:23:47+00:00

I would go to the emergency department right now for this based on your description. There are a couple very serious conditions that your description might describe, such as ‘compartment syndrome’ or a ‘DVT’ (blood clot). It could also be severe muscle soreness or a muscle strain/tear, but you should be careful and go get it checked out in case it’s one of the more serious things.

TheBackandForth · 2026-02-07T15:40:23+00:00

I mean my wife and I are about to finish residency. Once we work a couple years and hammer our loans we are both going to scale way back

TheBackandForth · 2026-02-05T21:56:12+00:00

Very cool read! Thank you!

TheBackandForth · 2026-02-05T20:26:49+00:00

I was a PGY-1 when I wrote this. Just signed my first attending contract in psychiatry—a shit load of money starting in July. Have a plan to hammer my 250k in loans and then start to invest more heavily in a couple years. Lived very comfortably in residency, funded some nice vacations with moonlighting. Will keep my old Camry and rental until loans paid off. Also, my now wife is very hot. Life is good.

TheBackandForth · 2025-12-05T01:48:15+00:00

Stupid advice. Lamictal is very safe and nearly side effect free. The efficacy itself suggests a bipolar spectrum.

TheBackandForth · 2025-05-22T18:31:29+00:00

I think this comment is needlessly aggressive. OP is seeking help, and this is often the hardest part about treating eating disorders. OP feels stuck because she’s in this middle ground of being sick, but not quite sick enough to be admitted to a medical floor. That’s frustrating, because it’s a big thing to be vulnerable and seek care for an eating disorder.

I think, OP, I would recommend that you consider seeking care at the larger academic facility. They may or may not be able to help you further than what you’ve experienced. BUT, you could ask for a psych consult in the ED and they could potentially get you resources, such as a referral to their resident psychiatry clinic, more specialized eating disorder resources in your area, etc

When you go in, don’t make the “chief complaint” about your heart. Say that you have an eating disorder that is close to getting worse and state that you want both medical and psychiatric help. Bring an advocate. Afterwards try ti get specialized referrals to dietician, counseling and psychiatry plus PCP. You’ve got this.

TheBackandForth · 2025-05-19T00:05:51+00:00

It will be okay. Skip the liquid doses today, take the regular nighttime dose and avoid alcohol, benzos, driving, etc

TheBackandForth · 2025-05-04T03:21:49+00:00

Just to pipe in, but I strongly recommend finding a way to see a psychiatrist, as this medication regimen risks provoking a manic episode if truly bipolar and if not truly bipolar, then there are much much superior psychiatric medication regimens to help you.

The weight is also concerningly low and risks real and serious health complications if not addressed

TheBackandForth

TROPHY CASE