A couple of hematology questions

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trickybilly

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Hello,
I'm new to these forums, nice to be here. A couple of hematology questions:

1) (R)CVP vs (R)CHOP? I read that both are given for NHL. Please tell me in short, practical terms when is one used and when the other.
2) PAD vs TAD chemoterapy?

I have read that both are used in multple myeloma. Please tell me in a short, practical way when one is used and when the other.
3)
Multiple myeloma vs plasmacytoma vs Waldenstrom? I tend to mix up these. Please help me
4)
Electrophoresis interpretation? As I understand that it shows albumin level, if gama globulin is high it can be a from plasmacytoma (or MM?), and alpha 1, alpha2, beta 1, beta 2 are for inflammation/tumors (no?). Am I getting this right? What is the difference between a1, a2, b1, b2? What practical knowledge do I need to interpret electrophoresis quickly and precisely?
5)
Immunofluorescence interpretation? I see it is sometimes ordered after elecrophoresis @ hematology ward. I am learning, but unfortunately I am afraid to ask senior docs (they bite or smt). So when do I order this test? How to quickly and precisely interpret it's results in everyday practice? Please give short and practical answers.

Best wishes

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@gutonc Lol, the GP kind. I am a student too in a way, specializing internal medicine. It is not a shame to ask a question, but it is a shame if you do not know, so if I ask trivial things please do not please do not facepalm so hard. Textbooks mostly teach me about inpractical stuff 1000s of "molecules, receptors" - from much of that knowledge the patient could die, it helps that much - while here you cannot ask any senior doc (respect to some exceptions) since they won't answer or would bite. In my small country *not-sharing* knowledge is in fashion, unfortunately. Maybe I should change my status to "student" to save reputation of the profession, but I need some answers lol. I am the opposite of those who are all about the title, and better be a "student" here and learn and ask freely than to be an "attending physician" and have restrictions. Yet, I think, I could contribute much too to help fellow students, especially those who are pre-graduation - I would gladly explain stuff :)

Work experience before specialization: GP ordination, Emergency Medicine Ward @ hospital (worked alone, no supervision), 1 year of teaching to nurses.
 
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I think he means do you have a medical degree (M.D. or D.O.). We dont know what "GP ordination" means but it does not sound like usa training.

Also all of your questions could be answered by a second year medical student. Or found on UpToDate.
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I am an M.D.,
First, I would like to contribute to this site, help people if they have questions (foremost in pathophysiology, internal medicine, physiology, hygiene) and be useful. I do not wish to argue. I am happy to contribute to someone's learning, and the knowledge I learn from my questions would be eventually shared as well. Please be so kind to consider my point of view as well.
To be real, a second degree medical student, as you said, hardly could have answered my questions since I think everywhere in Europe, internal medicine is a 4th year subject (except internal propedeutics which was 3rd year), even pathophysiology is 3rd year. 1st year was mostly anatomy 2nd phisiology, biochemistry 3rd patology, pathophysiology, microbiology 4th internal medicine, infectology, neurology... 5th pharmacology, pediatric medicine, forensics,etc and there was even a 6th year in some countries which was centered around practice. I have used all main USA based textbooks too (Harrison, Robins&Cotran, Guyton, etc.). Actually I have looked up all these questions in textbooks or internet (for example a detailed text about when to use PAD and TAD), but it is always nice to hear explanation from someone who is using these on the daily basis. Some textbooks tend to - as university professors also point out - distance themselves from practice (some do not even approach it), how many times they shy away for giving doses, practical recommendations. So to my question PAD or TAD I would expect an answer foremost from someone who had the authority and knowledge (hematologist) to prescribe this to patients and learn from his experiences. I doubt that any of you were such a person. I wish you all the best and would kindly ask you not to get offended and consider my point. I have no intention to bother anyone and will look and find my answers elsewhere. I wish you and these forums all the best though. Please understand.
 
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Hello,
I'm new to these forums, nice to be here. A couple of hematology questions:

1) (R)CVP vs (R)CHOP? I read that both are given for NHL. Please tell me in short, practical terms when is one used and when the other.
RCHOP when you want to cure them, RCVP when you don't.

2) PAD vs TAD chemoterapy?
I have read that both are used in multple myeloma. Please tell me in a short, practical way when one is used and when the other.
When you want to treat patients from the late 20th century, flip a coin and decide how much you hate them.

Nobody uses Thalidomide in the US anymore. Or Adriamycin for myeloma for the most part either. These regimens are outdated and inferior to modern therapies.

3) Multiple myeloma vs plasmacytoma vs Waldenstrom? I tend to mix up these. Please help me
Easy one:
Liquid; Solid; Crazy

4) Electrophoresis interpretation? As I understand that it shows albumin level, if gama globulin is high it can be a from plasmacytoma (or MM?), and alpha 1, alpha2, beta 1, beta 2 are for inflammation/tumors (no?). Am I getting this right? What is the difference between a1, a2, b1, b2? What practical knowledge do I need to interpret electrophoresis quickly and precisely?
As a generalist? You need to know that one of them is abnormally high and then read the pathologists interpretation. Then you need to know how to contact the hematologist and you can move on to the next patient.

5) Immunofluorescence interpretation? I see it is sometimes ordered after elecrophoresis @ hematology ward. I am learning, but unfortunately I am afraid to ask senior docs (they bite or smt). So when do I order this test? How to quickly and precisely interpret it's results in everyday practice?

You don't. Again, that's what pathologists are for. I've been in Hem/Onc (training and practice) for 8 years and can count on 4 fingers the number of times that I've seen this done on a bone marrow or other biopsy.

Something tells me that, although you used the blanket statement of "Europe", you're in a 2nd world, resource limited, country where the practice is 10-15 years behind the US and Western Europe.
 
to the OP, much like in the medical word, you can't ask basic questions without stroking peoples egos first. these two guys arent exceptions. you have to tell them how great they are before asking a questions that is, god-forbid, too basic for their massive ability, otherwise you give them an inch and they'll chide you.

most med students (including cbrons) cant answer these questions, yes you can look it up but it makes sense to me to have the opinion of people in the field, but the mods today are basically resistant, difficult and here for self praise. it was easier in the old days to recv better answers

just sayin'

I think he means do you have a medical degree (M.D. or D.O.). We dont know what "GP ordination" means but it does not sound like usa training.

Also all of your questions could be answered by a second year medical student. Or found on UpToDate.
Sent from my SM-N910P using SDN mobile
 
to the OP, much like in the medical word, you can't ask basic questions without stroking peoples egos first. these two guys arent exceptions. you have to tell them how great they are before asking a questions that is, god-forbid, too basic for their massive ability, otherwise you give them an inch and they'll chide you.

most med students (including cbrons) cant answer these questions, yes you can look it up but it makes sense to me to have the opinion of people in the field, but the mods today are basically resistant, difficult and here for self praise. it was easier in the old days to recv better answers

just sayin'
:rofl:
If you have a second to get down off your high horse and read my posts, you'll see that my first post was just trying to get an idea of where the OP was coming from. The post sounded like somebody working on a MS2 CBL case during their hematology block. With a little background, we can all have a better idea of how to answer the question. Just because somebody chooses "attending physician" on their profile, doesn't mean they really are.

My 2nd post was kind of snarky, but nothing out of the ordinary.

My 3rd post answered every single question.

I will be honest and say that I didn't read the OPs 2nd post here because...holy crap man...line/paragraph breaks. They're free, even in the former Soviet Bloc. Use 'em.
 
to the OP, much like in the medical word, you can't ask basic questions without stroking peoples egos first. these two guys arent exceptions. you have to tell them how great they are before asking a questions that is, god-forbid, too basic for their massive ability, otherwise you give them an inch and they'll chide you.

When nerds get in a position of power (real or imagined), they tend to get real mean.
 
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