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

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

新しい日本のキノが登場！

すごい新しい日本のキノがドロップしました。この可愛いけど強くて勇敢な少女が困難に立ち向かい、勝利をおさめます。裸足のショットが多く、クリエイターの高度なアニメーション技術を示しています

楽しんでくれると嬉しいです、ドラマターズ！

>hihi haha but not hihi haha to me ! Da frick I should guard that object, that object has max 30 person. Ok this object will get hit and ? 30 people will be gone, that's just 30 and not minus 100 so no big deal lol kek

She gives reason why she walks far away from object she suppose to protect

😔 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

Did you know that cheetahs meow, just like the house cats? 🐆 pic.twitter.com/mdbEiLjN0E

— Olga Bazova (@OlgaBazova) May 5, 2024

This one is live but better tho

Basically he wanted to do all Christian holidays in Ukraine on same day as catholic have. He failed but also probably later realised there ain't much of Christianity left in the west Europe