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

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.

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.

>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

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

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

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.

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

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

Was over at a local casino and won about $7500 on a 2/5/5 table. Kind of pissed I couldn't smoke or drink at the table but probably saved me from a few hero raises.

Covered a 4 hour shift in Psych ward today so my friend could catch a flight. Went pretty well and then got a patient that was death glaring me, threatening to kill himself and me while masturbating using urine as lubricant. Fricked out of there and reread the report and it was a grown adult upset that he was asked to wash some dishes that resulted in a psych evaluation in the ER.

I don't have enough Grey Goose to deal with this.

Tomorrow will be Putin inauguration. So UK couple days ago told it's ok for khohols to hit Russian territory with bongs weapons. Russian called some bongs and frogs diplomats and told they will consider shadow storm attacks on Russian soil as direct attacks from bongs. + started Russian started some wired exercises today that suppose simulate Russian nuking Ukraine. The idea is that Ukraine today/night strike Crimea bridge so will see tomorrow if they still decide to go with it.

In Eurovision probably Croatia is going to win. Good chances have Dutchcels. Then typical Cyprus and other high energetic young girls in bikini. Ukraine has nice song and performance, people in Eurovision like gypsy music and khohol song is very gypsy but khohols starting to have gypsy status in Europe and that's a no no so today a lot of people actually hate khohols in Europe so I'll be legit surprised if they will win despite they have a good number.

Italy is also something europoorian will love. Many think Swiss has decent chances it's a gay ballade and Eurovision is a gay show but the Swiss guy is like legit gay and that not something people like in Eurovision you are ether a stealthy gay like that Dutch arcane singer or like ultra comical open gay. So normie gays out

Good luck