Occasionally Preposterous, Repeatedly Scrutinizing, and Sporadically Egotistical: My Two Cents

Last post I made a bad joke about matcha and myeloma, so I figured that I would continue this week. However I don't have any good puns right now, but once I have some tea'd up, I'll let you know. See what I did there? Just call me Shakespeare 2.0. Speaking of 2.0, the patient is a 60 something woman with relapsed multiple myeloma (rMM) after a stem cell transplant (SCT).  So now everyone knows what MM is from my last blog post but what about when it comes back? It is a sad truth that many, if not all, cancers that relapse are more aggressive and resistant to therapy. For a widely dispersed malignancy such as MM, this is no different. So most patients have their SCT then go on an immunomodulatory drug like lenalidomide. Now what? Another SCT can be an option for some of these patients, following a similar model of the first, if the relapse is more than 12 months out. If less than 12 months, typically get varieties of chemotherapy that they have not used in the last round.  A...

The title is what happens when discussing ideas with one's fiancé while she looks for a good place to get a matcha latte. I will say, catchy. And while matcha is a joke, there is nothing funny about multiple myeloma (MM). My first question is why multiple? Is it just a descriptor? Since there are many smarter folks out there, let me give you what the NIH: National Cancer Institute says about that: " Plasma cell neoplasms occur when abnormal plasma cells form cancerous tumors in bone or soft tissue. When there is only one tumor, the disease is called a plasmacytoma. When there are multiple tumors, it is called multiple myeloma." Ok, so it is more simple than  I imagined but at least I learned something. Don't worry, you can laugh at me if the answer was already obvious to you. Anyway, continuing on, let's  start with plasma cells. They begin life as B lymphocytes that form in bone marrow and eventually leave home to start a life of their own in the big city and bec...

Gobbledygook? No, acetaminophen, also known by paracetamol or in this post, APAP. FYSA I do not have any affiliation with any name brands in this post. The ubiquitous Tylenol, with many other brand names is common on store and bathroom shelves and hospital MARs across the world. Back pain? Pop a few APAP. Tweak your shoulder? APAP. Fever and chills? Can you say APAP? The car driving slow in the left lane giving you a headache? Don’t throw the APAP at them just take it PO.  For pain control, acetaminophen is widely used and considered a very safe medication by many healthcare and non healthcare people. The indications are pain and fever alone or combined with NSAIDs or opioids, and it can be give. PO, rectally, and IV with some studies on IM being conducted as well. As we learn that more PO medications may be as effective as IV versions, so PO APAP is actually more effective that IV.  In a previous post I talked about some pain control methods and discussed the benefits of addi...

I prefer Great Value brand non-stick cooking spray. Even as I work to be healthier, sometimes good 'ol superdehydrogenated uber processed oils are just what you need. Benzodiazepines (BZD). See the connection? Oils are fats. Fatty liver can be caused by alcohol. Alcohol can cause withdrawal and seizures, which you then treat with benzos. Bam, check mate. Aside from the first BZD, chlordiapoxide, the rest end with -pam or -lam; diazepam, lorazepam, alprazolam, etc... Hence the pam in the title. Genius I know, you don't need to tell me that.  So I mentioned that BZDs can be used for withdrawal from alcohol but that is just one of many uses. Panic disorder, agoraphobia, epilepsy, anesthesia adjunct, insomnia, and many kinds of seizures are just a few, so BZDs really are a jack of many trades. They can be given PO, IM, IV, and rectally and are generally well absorbed, then they go on to work on receptors in the central nervous system to cause CNS depression. Makes sense given their...

Mainly tax, yes, you have to say talking with an accent to make it work but since when did I care? Does it relate to the topic at hand? Nope. What is that topic you ask? Ok I guess cause I like you, paclitaxel, docetaxil, and cabazitaxel. The first two are quite ubiquitous in cancer treatments for a wide range of cancer types. They belong to the taxane family and were originally derived from the yew tree. Which is good for my family since I just planted one. Oh? It doesn’t work that way? Damn.  On a tangent (oh no you would never!) it is incredible to me how many medications originally derived from nature. Ok it makes sense that they might appear somewhere. But the evolutionary process to have a yew create a compound like paclitaxel? I didn’t do any research but I would guess that’s not why the tree has it but it is just an incidental compound. Either way. Nature = cool.  Why do you care? For me, it goes beyond interest and into the repercussions these medications have on pati...

It’s sad when I see a patient who “let it go” in regards to troubling skin issues. I know it’s a problem in healthcare generally, but I usually see the skin. It’s sad when people fear the cost and it ends up costing their lives, it also mystifies me when those with good health coverage put off care. I do understand on a very basic level, I was a stubborn 18-24 year old male and a Marine on top of that. So of course I was much to tough to deal with issues, and I pay with premature aches and pains. I’d gladly take that over cancer however.  An elderly elderly (yes two, thanks TWIV) woman has a growing red lesion on her breast that is tender, erythematous, enlarging, and eventually starts to ooze. It’s easy for me to say initially, why did that have the chance to grow so big? That’s the wrong question I think, blame is easy but not commonly a good idea. For a young 30 something woman, an enlarging, tender, firm mass would be concerning. If you have dyskinesia and need help to get dres...

Really, it’s cutaneous but that doesn’t roll of the tongue as well as skinny. In the past 7-8 months, 3 pathology reports came back as lymphoma, from patients 18-75. That was at a dermatology clinic, in three years and five months I hadn’t seen one and the clinic sees A LOT of patients. Coincidence? Probably. Alien implants going haywire and causing cancers in abductees? No but that would make an interesting story line. I’m more partial to secret societies beaming 5G to every household and causing the human race to die off. Still probably not but you’ll find me in my Faraday Cage. Enough of that, let me set my tin foil hat on my ark crystal, it needs to recharge. Lymphoma? Isn’t that a malignancy of the lymph system? Yes indeed it is young grasshopper, specifically arising from lymphocytes. Lymphocytes are white blood cells (part of the immune system) and make up between 18-45% of all circulating white blood cells.  There are a huge amount of variety in subtypes of lymphoma, check ...