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.

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.

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.

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

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