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

Had to fly red eye and still need to do another 30 hours as well as like 400 hours that we cannot legally say and will just be between the medical board and myself. It's going to be over 3 months. Just have me do 115 hour weeks so I can knock it out in a month.

thx

!moidmoment !besties !r-slurs !pings

Her insta is a banger mix of sad and based

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.

My bf is a bit of a nerdy physics guy right now, so like mega beta. I'm trying to convert him into an alpha for me, any suggestions? things which i have been doing:

• encouraging him to work out (he used to and he's still kinda strong)

• encouraging him to punish me when i misbehave

• submitting myself to him

Ive had good results so far, in the beginning he was just a shy little nerd, now he grabs and controls me whenever he wants. i have been asking him to beat me but he has refused. how can i take this to the next level? importantly:

do u think that cucking him with that girl will help in his alpha development? or will it cause a regression into beta status?

!women !cuteandvalid

!football

www.theguardian.com/us-news/live/2023/jul/19/george-w-bush-former-us-president-dies-aged-77-latest

be me

excited to celebrate Pizza Day with all my !friendsofpizzashill

jump on groomercord to wish everyone a “good sorning”

“Oh a new message from Mr. Shill himself! Maybe he got my invite for todays party!”

*reads message *

I feel the power of a thousand knives sharpen through my back like wings of a demon growing.

The fire in my eyes start to glow with rage.

You’ve just made a fricking enemy for fricking life Pizza. Expect more to join soon and I’d watch my fricking back if I were you

Sincerely,

ME and !enemiesofpizzashill

JOIN THE MOVEMENT!!

Yes groomercord iscancer, but this is worthwhile

CLOSED

Covering for a friend remotely and patient on plavix is mad that I ordered recommended they go to the ER. I'm about 1100 miles away and I don't even know what hospital they go to typically. Go to the ER, get a CT and then follow up with somebody else because I'm only doing this given my friend is sick.

Got an email asking if I could help as on on-call ER consult to some small school full of a bunch of fricked up r-slurs. 75% are suicidal and the others just yell and scream the second they aren't given whatever they want.

I'm not some charity, I do the bare minimum to be able to practice in the ER, I'm busy as frick paying another favor and people haven't realized I truly don't give a frick. Their and the school value is worth less than my bottle of grey goose.

1. Plastics in multi-generational life cycles. Pthalates and bisphenols specifically.

Source: Google scholar "plastics endocrine"

2. Social contagion. "Social media" isn't for everyone. It's a powerful tool that not everyone should have access to.

Source: common sense