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PaperclipPerfector  1mo ago (text post)   2892 thread views

Small-Scale Question Sunday for October 12, 2025

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

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I went blind again. Before anyone panics, it was for less than an hour, and I'm fine now.

I was previously diagnosed with a condition known as central serous chorio-retinopathy, where fluid leaks out of the vessels below the retina and makes it bulge out. It is usually due to corticosteroid consumption, which I've never done, but also due to prolonged and severe stress. Guess what I'm experiencing?

This isn't the first time. In keeping with a now-obvious pattern, it happened to me before a high-stakes exam. Once before the PLAB 1, again before the MSRA. And now, the MRCPsych Paper A looms ahead of me.

My stimulants might contribute (they're stimulating the sympathetic nervous system too), even if I take very reasonable doses. Unfortunately, my ADHD is not an affectation, I can't study without my meds, let alone pass exams. Especially exams that require months on end of grinding and memorization, when is rather be doing anything else.

So yeah, same choice as usual: lie flat, or keep fighting. I'm inclined to do the latter unless the attacks become so severe that I'm at great risk of permanent visual damage. I did see a doctor once, and it was decided that a waitful watching system was appropriate, instead of jumping to options like intravitreal injections or lasers. It's been a year and a half since then, and this attack was mild, so I suppose it wasn't the worst advice.

Anyone else have a few dangling Damocletian swords above them? Aimed at their eyeballs? Alternatively, what's the best way for me to manage my stress, when giving up or foregoing my meds isn't an option I'm willing to consider?

(I'm going to order myself some green tea. It helped in the past.)

Fuck, I’m sorry.

I have stress-provoked tachycardia which is less crippling but certainly unfun and produces perhaps a similar ‘I need to do important things to have a good life but not too many things or else my body will go wonky’ dilemma.

I’m sort of failing to manage it at the moment but generally I would advise trying to separate out one’s stressors a bit. Don’t go drinking the night before the marathon. Try to have specific study times that don’t coincide with your worst work shifts. If possible, try to have the confidence that you can take a break every so often without fucking up your life.

Thanks my dude. Misery loves company!

(Also, I will probably be in London sometime between Monday to Wednesday next week, let me know if you're free. We can be miserable together in person.)

I have stress-provoked tachycardia which is less crippling but certainly unfun and produces perhaps a similar ‘I need to do important things to have a good life but not too many things or else my body will go wonky’ dilemma.

I presume you've gotten that looked at? My impression is probably anxiety, and CBT or the drugs would help if that's the case. Maybe even just a beta-blocker for symptomatic relief if it gets bad.

I’m sort of failing to manage it at the moment but generally I would advise trying to separate out one’s stressors a bit. Don’t go drinking the night before the marathon. Try to have specific study times that don’t coincide with your worst work shifts.

I won't be drinking before the exams, and I've already cut it down to a single night of dissolute enjoyment at the pub. They miss me, but I actually need to lock-in.

I try to study at sensible hours, but easier said than done.

If possible, try to have the confidence that you can take a break every so often without fucking up your life.

That's true. This exam isn't the end of the world if I fail, just £500 I won't be getting back. But I do very much want to pass it in one go - deferring it is an option, but I'll only be getting busier in the future and I'm already a bit overdue for an attempt.

To moan in general, the exam is designed by sadists, with much of it of limited/negative utility in actual psychiatric practice. But I am not credentialed enough to be consulted on such topics, so I'm dealing with it. It's also pointlessly hard, but eh, I can manage that too.

Thank you for listening, it means something to me.

I will probably be in London sometime between Monday to Wednesday next week

Cool! That's today to Weds, or next week?

I presume you've gotten that looked at? My impression is probably anxiety, and CBT or the drugs would help if that's the case. Maybe even just a beta-blocker for symptomatic relief if it gets bad.

Had keyhole surgery (catheter ablation) a couple of years back when it flared up to multiple several-minute bouts of 180bpm a day. Much better now, only once every few months, but I live in fear of it getting worse and needing surgery again. Realistically could be a lot worse but it's made me risk-averse in a way I dislike.

That's true. This exam isn't the end of the world if I fail, just £500 I won't be getting back. But I do very much want to pass it in one go - deferring it is an option, but I'll only be getting busier in the future and I'm already a bit overdue for an attempt.

To moan in general, the exam is designed by sadists, with much of it of limited/negative utility in actual psychiatric practice. But I am not credentialed enough to be consulted on such topics, so I'm dealing with it. It's also pointlessly hard, but eh, I can manage that too.

Good to hear that it's not do-or-die, at least. Worst comes to the worst, spreading the study out over a longer period will make you much more likely to retain the knowledge.

Best of luck!

Had keyhole surgery (catheter ablation) a couple of years back when it flared up to multiple several-minute bouts of 180bpm a day. Much better now, only once every few months, but I live in fear of it getting worse and needing surgery again. Realistically could be a lot worse but it's made me risk-averse in a way I dislike.

Now that is far more serious than I'd like. Did they not give you beta blockers for as-required symptomatic relief? Did the surgeons or cardiologists not give advice regarding lifestyle modifications or exercise tolerance? This is far out of my wheelhouse, but I don't want you to be unduly anxious, even if you are right to worry.

Cool! That's today to Weds, or next week?

Next week! I'll DM you closer, once I know the exact dates.

Best of luck!

Thank you again!

I've got a tab of verapamil, which is similar to a beta blocker. In practice they've usually died down quickly enough that I don't have time to fetch and take it, which is good.

Did the surgeons or cardiologists not give advice regarding lifestyle modifications or exercise tolerance?

They did, in Japanese lol. Broadly they said, "Look, just don't worry about it. Do whatever exercise you like - it won't help but it won't make things worse. In practice go on living your life the same as ever." Which is... nice and all, and better than the alternative, but somehow less reassuring than 'eat salad, never let your heart get above 160, and we want you to wear a 24h ECG once a year' or whatever. I try not to think about it too much, or else I will turn into a hypochondriac.

It seems to be genetic (at least one of my elderly relatives used to have it I think) and to die down as you get older.

Verapamil is a calcium channel blocker, and a good option. I don't recall off the top of my head whether it's superior to something like metoprolol, but it is very reasonable to prescribe.

They did, in Japanese lol. Broadly they said, "Look, just don't worry about it. Do whatever exercise you like - it won't help but it won't make things worse. In practice go on living your life the same as ever." Which is... nice and all, and better than the alternative, but somehow less reassuring than 'eat salad, never let your heart get above 160, and we want you to wear a 24h ECG once a year' or whatever. I try not to think about it too much, or else I will turn into a hypochondriac

I'm sorry, I had to laugh. This is a good reminder that patients are not made alike, some of us need gentle reassurance, others desire bright lines in the sand. In all honesty, I think telling someone not to let their HR cross 160 either won't work or will be counterproductive. The anxiety of watching it maybe go to 140 might easily cause it to spike.

Something like an Apple Watch with ECG tracking might be good just for the peace of mind. I told my dad to get one, and even offered to pay. Unfortunately, despite getting a heart disease so rare it was until recently thought to only happen to the Japanese (coincidence?), he's proof that doctors make bad patients.

If you want to DM me the exact diagnosis, I can probably give you better advice, but I am still a psychiatry resident and I am blissfully forgetting everything about cardiology other than measuring QTc elongation on a trace.

It seems to be genetic (at least one of my elderly relatives used to have it I think) and to die down as you get older.

If they lived to be elderly, don't you think that's a good sign?

Much appreciated! I'll take you up on that and DM you if I ever need a serious talk, but I'm quite all right for the time being. I'm not worried about dying per se, but the original surgery was very much Not Fun for various reasons (I woke up during the operation) and I'd like to avoid being in that position again if I can.

Something like an Apple Watch with ECG tracking might be good just for the peace of mind. I told my dad to get one

Very useful in some ways, surprisingly un-useful in others. It lets you have a look and get an idea of what is 'normal' and what is 'not normal' on a moment to moment basis. It's less useful in that many conditions produce the same biomarkers. For example, low heart rate variability can either be a sign of relaxation and recovery (good, go and get some exercise) or your body desperately trying to relax and activating the parasympathetic nervous system after serious exertion (maybe not good, you need to relax and not do anything strenuous). Low stress just before you wake can be a sign that you're well-rested (good) or that you're very tired and your alarm woke you in the middle of a sleep cycle (less good). And so on.

Ideally sensors are a good way to sort through the psychological chaff such as excess stoicism or excess hypochondria/anxiety and get a good idea about what's actually going on with people, but it doesn't seem to work that way. There also seems to be a dearth of individual high-detail studies, just very specific medical studies on unusual cohorts or vast field surveys.

I'm sorry, I had to laugh. This is a good reminder that patients are not made alike

I imagine this comes up a lot :) But for certain types of people saying 'I would love to do X with you but the doctor says I can't because of Y, what a joyless bastard he/she is amirite?' can be much easier than saying 'I'd like to do X but it makes me nervous'. I don't know how you'd go about finding which patient responds to which approach except through experience and stereotyping, but I bet it has a big payoff especially if you ever go private.

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