The fricking cwowld metwl slid owor my skin like silk sliding dwown a fricking banyister. It dwoesn't take much pwessure wen u have a fricking sharp razwor. Bwood came pwouring immediatewy. That's a fricking gwood sign - the fricking deep cuts are fricking bwight white and take a fricking minyute two start bleeding. I am onye with the fricking pain because I deserve it fwor being worthless and a fricking piece of shit and a fricking bad perswon.

Am I bwoken that my mind cwonstantwy instwucts mwe two self-mutilate, b-word? It feels like there's a fricking gwoblin in my head (the Gwueswome Gwoblin) cwonstantwy egging mwe on two dwo the fricking nyeedfwl and start slicing. Can anyonye relate, b-word? I knyow I'm gwoing two dwo it again twomworwow and it's gwoing two be wose. The fricking cycle's begun again.

Figured I'd help out last second and fly back to California. Flight connection got cancelled so offered to do telehealth but said I'd be a couple hours late and have to cancel some appointments. Apparently the response is cancel 5 more appointments and just be a peepee to somebody with privileges trying to help out? We didn't even agree on payment outside of the flight they got fully refunded for. I know we're not exactly on good terms given I've fired their best friend, hated her and responded negatively to her getting the job behind her back but she reached out to me and shit just didn't work out. Life happens sometimes.

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

Patient presents with severe anemia pulse Ox 89%, neutropenia and possible pancytopenia upon blood work. Final diagnosis was stage 4 bladder cancer so how did we end up at that diagnosis?

69 y/o male presents after multiple bruises and bone pain, neuropathy and paraprotein general screening. Further testing showed non IgM paraprotein. There are only 2 diagnoses that makes sense so start asking questions for this very obvious guided answer.

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.

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

The drunk r-slurs in the Alberta government are upset the public isn't buying their Alberta Pension Plan bs, plus them shoving Bill 20 onto Albertans.

Bill 20 creates political parties at the municipal level in Alberta, 70% of Albertans don't want that. And it also allows for the Cabinet to fire democratically elected city councillors behind closed doors, and then there's the r-slurred ban on electronic tabulators.

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