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https://marcellusdrilling.com/2017/01/magnum-hunter-changes-its-name-leaves-the-bankrupt-past-behind/ ask Equity concepts - why don't us Magnum Hunter investors own a part of the new company? Buffet sitting on $128 in cash (Bonds) https://seekingalpha.com/article/4329448-buffett-lost-90-billion-not-following-own-advice?li_source=LI&li_medium=liftigniter-widget https://www.cefchannel.com/preferred-stocks/ https://cefdata.com/index/details/462/
Georgia Bonds, age 80 overweight black woman on chronic oxygen therapy in wheelchair - very friendly accompanied by two very friendly gentlemen. Biggest problem is her intractable low back pain/sciatica. DISEASE FEATURES IgG kappa monoclonal protein 0.9 2020 IgG 1719 and kappa 198 and K/L 14 at Dx Various xrays negative for lytic lesions PREVIOUS TREATMENTS . CURRENT TREATMENTS . Disease Status: . Treatment Goal: . ACTIVE PROBLEMS Monclonal gammopathy, 3/1/20 COPD Advanced age Diabetes Mild neuropathy Mild anemia Chronic midline back pain with bilateral sciatica Obesity CKD, grade III Low back pain/sciatica INTERIM HISTORY AND ASSESSMENT Ms. Bonds has an IgG kappa monoclonal gammopathy. We don't yet know whether this is an aggressive process that will need treatment or a stable process that will not. I hope the latter because she is 80 and in a wheelchair a lot and on chronic oxygen, and just does not look to be a good candidate for chemotherapy. She does not seem to have any problems related to this monoclonal gammopathy, but that is what we are trying to sort out. We will check with her nephrologist whether he ever tested for monoclonal proteins in the past and get those results if he did. I might consider an MRI of her L-spine because she has chronic sciatica and it would be good to make sure there is no lytic lesion there. She had an xray in 2017 that showed severe degenerative disk disease at L5S1 which may well explain her pain and for which there is probably not much we can do as she is a terrible candidate for back surgery. Unfortunately, she is very heavy, so that makes her pain worse and makes it difficult for her to change positions or ambulate, so she does a lot of sitting and eating. We did talk about a low carb diet, but I'm not optimistic she'll do anything with that info. I'm not anxious to put her through a bone marrow biopsy. I'm pretty sure it will show a moderate amount of plasma cells like 20%. I think the main issue is the stability of this protein, so we'll check the levels again in 3 months. In the final analysis, unless this is a very aggressive process, treating seems unlikely to improve either the quantity or the quality of her life. Past Medical History: Diagnosis Date • Acute on chronic respiratory failure (HCC-CMS) 7/23/2019 • Anemia • Arthritis • Asthma • Bilateral venous insufficiency • CHF (congestive heart failure) (HCC-CMS) • Chronic kidney disease • Chronic obstructive pulmonary disease (HCC-CMS) • Diverticulosis • DM (diabetes mellitus) (HCC-CMS) • Environmental allergies • Fatigue • Gastroesophageal reflux disease • Gout Hx • History of mammogram 12/9/13 • Hyperlipidemia • Hypertension • Obesity • Sleep apnea • SOBOE (shortness of breath on exertion) Past Surgical History: Procedure Laterality Date • CATARACT EXTRACTION Bilateral 04/2010 Dr Lavery • COLONOSCOPY 02/04/2013 Dr Beyer; due 2016; Diverticulosis/Hemorrhoids/Polyps x 3 • HYSTERECTOMY • TRIGGER FINGER RELEASE Right R thumb Medications and Allergies have been reviewed and updated in the Mosaic system. REVIEW OF SYSTEMS Except as noted in the history and assessement above, all other systems are negative. EXAMINATION Vital signs were reviewed abnormalities discussed above. General: Looks well; overweight HEENT: conjunctiva clear; no jaundice Cervical nodes: none palpable Supraclavicular nodes: none palpable Axillary nodes: none palpable Inguinal nodes: none palpable Lungs: decreased sounds. On nasal oxygen CV: RRR Abd: soft and non-tender; no HSM; no masses Skin: no significant rashes Ext: Edema: none; Tenderness: none Neuro/Psych: Gait: wheel chair Speech: clear, but slow and halting Affect: NL Cognition: Oriented;
INTERIM HISTORY AND ASSESSMENT Mr. Dixon is referred for evaluation of his anemia. Though only 80, he has a host of medical problems and is very frail. Although he had a severe episode of hematuria a few years ago requiring transfusion, he does not seem to have had severe enough blood loss to cause his current anemia. His hgb has been low for about 5 years. His ferritin recently was 81 with a normal TIBC and mildly low serum iron and saturation. I doubt that he has iron deficiency, but I can't be sure it isn't playing a role and repletion of his iron stores would help Procrit work better if we go that route. He had an iron infusion 3 days ago an is due for a second in about 4 days. This should replete his iron stores and help to answer the question. I'll see him back in 2 weeks and check a cbc, retics, iron stores, etc, and then see him again 3-6 weeks later. If the anemia continues in the 7 - 8 range with repleted iron, then he would be a candidate for erythropoietin therapy. His has multiple severe medical problems and I think is no longer a candidate for any sort of aggressive or risky diagnostic or therapeutic procedure. Ever-other week Procrit would be fairly easy and could possibly improve his quality of life, though of course it would have zero effect on the quantity of his life.
Oncology History - can you tell what this means? Stage IV prostate cancer s/p prostatectomy in 2004 with one dose of Leuprolide in 2010. Newly diagnosed with T6 lytic legion and retroperitoneal metastasis. PSA elevated to 7.5. NEJM HAD ARTICLE ON INTERMITTENT VWS CONTINUOUS ANDROGEN DEPRIVATION IN PROSTATE CANCER, BUT THIS LOOKED AT 7 MONTHS COMBINED BLOCKADE, AND IN THOSE WHO'S PSA < 4 RANDOMIZED CONTINOUS OR INTERMITTENT adt. INTERMITTENT RESULTED IN SMALL BENEFITS IN QOL FOR ERECTILE DYSFUNCTION AND MENTAL HEALTH, BUT EFFECT ON SURVIVAL WERE STATISTICALLY INCONCLUSIVE. PLAN 12/27/17 TRELSTAR. 7/10/18 PSA 0.1, HIGH 16. 10/2018 PSA 0.3, HGB DECREASED, IMAGING STABLE TO SLIGHTLY PROGRESSED. Trelstar 11.25 mg IM every 3 months given with xgeva 7/819. Docetaxel 11/2019 it was repeated under Cancer of the Prostate on the problem list AAAaaa
Things I can't remember
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HEMATOLOGY / ONCOLOGY
@NAME@ @DOB@ Age: @AGE@
Date of service: 01/23/20
Location: BBC Oncology
Reed Brian Mitchell, MD
CHIEF COMPLAINT: .
Disease Status: .
Treatment Goal: .
INTERIM HISTORY AND ASSESSMENT
Medications and Allergies have been reviewed and updated in the Mosaic system.
REVIEW OF SYSTEMS
Except as noted in the history and assessement above, all other systems are negative.
Vital signs were reviewed abnormalities discussed above.
General: Looks well
HEENT: conjunctiva clear; no jaundice
Cervical nodes: none palpable
Supraclavicular nodes: none palpable
Axillary nodes: none palpable
Inguinal nodes: none palpable
Abd: soft and non-tender; no HSM; no masses
Skin: no significant rashes
Ext: Edema: none; Tenderness: none
Port: no inflammation
R. Brian Mitchell, MD
Under = <18.5NL = 18.5–24.9 Over = 25–29.9 Obesity = BMI >=30
G2 60 - 89
G3a 45 - 59
G3b 30 - 44
G4 15 - 29
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