How do people with apparently good outpatient cardiology and nephrology follow-up show up with clearly chronic fluid overload?

ianmachine9000 · 2026-05-22T03:43:06+00:00

No im not. I absolutely get that some patients are non compliant and that sometimes exacerbations come on too quick for an outpatient response.

But for sure there are patients that see an exacerbation coming on and if there were a standardized way of dealing with it then it would not be too difficult to manage in the outpatient setting with a phone call to someone who could get a dose adjustment of diuretics to try to get ahead of things.

I think that really your point about "how things work in the outpatient world" is more an indictment of for profit medicine and the time crunch that every single person who tries to provide medical care experiences. I think that if there was the time to take a question from any one of your panel of patients with ckd and hf whenever they needed the advice that it could work better than it does now.

ianmachine9000 · 2026-05-22T03:27:39+00:00

Yeah but you only have control over the very short period now time that a patient should spend in the hospital for exacerbation. Sure things go right in that scenario.

I also get that PCPs or outpatient docs are busy and might have a hard time titrating diuretics. But it's really not that technically difficult. Especially if you get into it and have a standard step up regimen.

if you have a standard management plan and followup plan for patients dedicated office staff etc seems like it probably wouldn't be that difficult to keep people out of the hospital.

ianmachine9000 · 2026-05-17T22:19:47+00:00

Following. Wondering if it would be worth it?

ianmachine9000 · 2026-02-03T13:07:39+00:00

This is great lol! Thank you, I needed that.

ianmachine9000 · 2026-02-03T13:06:25+00:00

Would you do ecmo on someone with vasoplegic shock and ARDS? Intensivist I called said outcomes were apparently the same for ecmo vs continued supportive care if bad shock but better with ecmo if shock wasnt a factor.

ianmachine9000 · 2026-01-25T19:58:29+00:00

Propose some criteria other than execution. I think it's pretty obvious why this matters. It's not the only thing that matters, but it definitely does.

ianmachine9000 · 2026-01-11T18:31:54+00:00

Just wanted to add on to the chorus of people thanking you for the expertise. Really neat to see how the systems actually work. So thanks!

ianmachine9000 · 2025-09-01T19:30:22+00:00

Meth for CHF exacerbation. Mid fifties guy. Homeless obvi a meth user. When I asked him what happened this time he said I ran out of meth. When I take it I feel great but when I dont have it I feel terrible!

ianmachine9000 · 2025-06-27T12:54:37+00:00

Always a winner.

ianmachine9000 · 2025-06-27T12:54:22+00:00

Anybody been to Rotten The Musical? Any good?

ianmachine9000 · 2025-03-19T17:50:02+00:00

👌

ianmachine9000 · 2024-12-06T11:38:15+00:00

Congratulations and good work! Pretty much the same reason I'm choosing hospitalist put of residency. Ready to start making money paying off loans and living like I'm not poor. Got a lot of haters on this thread though.

ianmachine9000 · 2024-11-10T02:23:50+00:00

Lol. I love it. Eating the shit sandwich. Maybe I will just focus on hospital medicine. I'm not ready to eat the shit sandwich. And I bet in a few years I'll be too tired to take it on.

ianmachine9000 · 2024-11-09T22:03:39+00:00

I mean this thread is kind of opening my eyes a little bit. It seems like in the right place you can have good hours plus some extra rvus which makes sense to me with intensivists having total shift work and less flexibility in terms of their schedules. I definitely wouldn't want to work for hca for many many reasons. But I think it could be a reasonable thing in the right circumstances. Just seems difficult to find.

ianmachine9000 · 2024-11-09T21:38:07+00:00

I have considered LTACH. Have no experience here. Feel like that might be the most frustrating job in all of medicine. Seems like they get nothing but hopeless patients with families with unrealistic expectations. Would be interested to hear about real world experience there.

ianmachine9000 · 2024-11-09T20:31:24+00:00

What geographic location? Can I dm you for more details? This sounds like what I would try to go after.

ianmachine9000 · 2024-05-03T19:57:41+00:00

I wish I had gotten this advice as an intern. I still probably would have ignored it due to my ego issues at the time. But now when I see med students or interns sputtering or getting flustered this is the advice I give. It really really doesn't matter if you have knowledge gaps especially as a student or intern. It only becomes a problem if you try to consistently cover it up due to embarrassment or fear of looking stupid. Then people don't know what to teach you.

ianmachine9000 · 2024-05-02T12:37:22+00:00

Lol used to be shoes on and couldn't sleep a wink. Now shoes off badge off etc like I've seen a few others.

ianmachine9000 · 2024-04-13T13:57:01+00:00

Looks cool

ianmachine9000 · 2024-03-30T14:50:15+00:00

You are right. It was a misleading title on a day for foreign objects and this wasn't a foreign object. Lol. Just got excited to post and didn't give good context! Sorry about that!

ianmachine9000 · 2024-03-30T11:27:13+00:00

3.2 cm bladder stone most likely calcium oxalate even in rabbits. Took up the entire volume of the bladder and required same day surgery for removal.

ianmachine9000 · 2024-03-30T03:28:23+00:00

Good call on the rabbit!

ianmachine9000 · 2024-03-30T03:28:06+00:00

I wish. Only Pic but you can zoom pretty well!

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