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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
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Helping out with my friends special needs kid and faking not being drunk. He is annoyed I have to look up specifics on gluconeogenesis like I remember proteins from 20 years ago.
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It's 5, I'm allowed to drink now. (Ignore the fact I was drinking this morning those in the group chat)
Had to spend the majority of the day filling out paperwork that literally should not be my problem. Some nurse was being bitchy because I used shorthand instead of printed English even though she should have known what I wrote. Now I'm just trying to put the past couple days behind me and enjoy Belvedere.
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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.
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π©π°πΊπ¦ Journalist of the Die Zeit Joerg Lau deleted his tweet and clarified that the F-16s will be in Ukraine within monthS.
— Lord Bebo (@MyLordBebo) May 14, 2024
So, not soon ... https://t.co/lxBaKtXpWW pic.twitter.com/zV3pkrVaAd
https://rdrama.net/post/268676/f16s-from-denmark-will-be-in
I can't keep getting away with this
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Also a future video from volchansl got posted
Dvinatsate nole patu = 12/05
Everything is fine in volchansk
Neighbor got me worried I was like βfrick did I just sleep a whole day ?β
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To me the actually fun part was that some of my black guy friends liked this post
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Pretty dysregulated this weekend so best option is to drink and goomble. Won about 2k in a private game but decided to start getting drunk. I'm about 3 four looks into the night so let's see how the rest of the day goes.
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Frogs soldiers won't come with new weapons since Ukraine already got 60% of frogs artillery so they are there just to fill the numbers. No matter what macron is planning it will end up being reputation damage to France especially in Africa. Frogs can max give Ukraine 20k men and that's literally nothing. Of course he is smart like smartest person in empty room. Side effect will that it will instantly rise Russian moral since they will now not only fight western tanks that they were supposedly afraid of and would run away from them but also legendary superior frog warriors that won't have exp in that fight and will be short on ammo
Macron hypothesis are
A: Russian won't cross the line and won't touch frogs soldiers
B: killed frog soldiers will anger frogs and start supporting sending more frogs to Ukraine and NATO countries will be very sad of dead frogs so they decide to also send their soldiers
This is 2 ideas. They have solid if you have no background info
But answer will be C: frogs will ask macron defack he send frogs to Ukraine and his and his bf (pm) ratings will go down and his bf will lose the next election
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Would you join these ladies in the woods? pic.twitter.com/cJBhJ0Khq1
— Nina π Byzantina (@NinaByzantina) May 22, 2024