Patient presents to PCP with swelling of the left clavicle persistent for 3 months. Hx of schizoaffective disorder, depression, hypertension and active multiple myeloma. Case goes into consult with multiple physicians. What are considered treatment plans?

For consideration

Heterogenous enlarging left clavicle mass (3.8cmx3.2cm)

Bone marrow suggests plasmacytoma with skewed kappa/lambda ratio, CD138 positive cells (value not reported due to conflicting lab results)

FISH showed 17p deletion.

Labs consistent with previously diagnosed multiple myeloma

Prior treatment included radiotherapy 1 month post initiation of a combination of lenolidomide, bortezomib and dexamethasone

In all honesty there are no correct answers and only incorrect answers. Possibly a pentad combination could work, you could adjust or go for removal of lenalidomide, change to a two factor drug, initiate differing cycles of dexamethasome could be beneficial due to refusal of ASCT by patient. This is how medicine works, there's no one size fits all and all we can do is attempt to help.

This was a case I worked on with people from MD Anderson, John Hopkins School of medicine, Mt Sinai, New York and unfortunately the patient refused all forms of treatment and expired.

To me the actually fun part was that some of my black guy friends liked this post

If you ad a cigan anywhere that would be as subtracting at least 10 non cigans

Didn't have much planned so I called in a lawnscaper who cleared my yard while I just got shit faced drunk off Voodoo Ranger IPS. Had a few old work related things to do but that took like 10 minutes and these bitches act like it take hours.

Now it's just time to play horizon: Zero dawn

😔 Russian military partially captured Keramik and advanced towards Arkhanhelske in the Avdiivka direction, — Suspilne. pic.twitter.com/q4OjNFEKFP

— MAKS 23 🇺🇦👀 (@Maks_NAFO_FELLA) May 4, 2024

Wtf is even partially captured ?

This village is fully captured

Someone even posted this epic cope map

What's the hold up on conscription and getting more bodies

Stop jacking it perverts that's gay

I wanted to call some posts dumb, it's dramaphoic to allow any kind of space I can't post in but can see

If they want their private dumb shit then it should be hidden

🤡🥴 Russian Ministry of Internal Affairs announced that Zelensky is "WANTED" under an unnamed article of the Criminal Code... pic.twitter.com/KjjDValoGN

— MAKS 23 🇺🇦👀 (@Maks_NAFO_FELLA) May 4, 2024

The comments making hihihaha but that's the first steep after 23rd they will declare him criminal. You technically can't call other leaders criminals but since Zelenskyy didn't did presidential election and what more important parliament election (Ukraine is parliament country) he can't truly legal cancel election since soon martial law will end in couple of days and only elected parliament can extend it so there will be a hole in legitimacy of Ukrainian gov.

Thus, if not for the war, the regular parliamentary elections would have taken place on 29 October 2023.

At that time Zelenskyy didn't filled presidential election

But he never talked about parliament elections. Because he was always sure his party was going to lose it.

Ukraine's parliament, the Verkhovna Rada, on February 6 passed laws to extend martial law and military mobilization for another 90 days as Russia's full-scale invasion nears the two-year mark. President Volodymyr Zelenskiy on February 5 submitted to the Verkhovna Rada the drafts providing for the extension of the two measures from February 14, in line with the provisions of Ukraine's constitution. This extension is the 10th time since February 24, 2022, when the Kremlin launched its invasion, that the parliament voted on the two measures. The extension will be in effect until at least May 13.

So in couple of days there won't be martial law in Ukraine and parliament can't extend it.

Russian argument that they can't sign any agreement with Zelenskyy because he ain't legal will have strong point and BRICS will support/understand Russian point

Its a bug, actual prices range around 25k(via Middle East). Wish it was real tho

wtf man