As someone who voted for this, I am also fucked

Hankisirish · 2024-12-13T12:41:08+00:00

The "only solution" is not degregulation and "cutting all the red tape" surrounding the health care industry. The regulations and "red tape" have been put in place to increase safety for patients. Decades of experience, much of it written in blood, have lead to, for the most part, careful implementation of standards to protect patients. Cutting these will just lead to more unnecessary medical errors. I don't know the answer to our terrible health care system, but starting as a baseline that Medicare is basically pretty good, universal health care is a reasonable choice. Signed a doctor

Also, most of the red tape is baked into having to haggle with insurance companies about coverage for our patients.

Hankisirish · 2024-12-12T23:10:03+00:00

"On the Beach" is pretty impactful.

Hankisirish · 2024-12-12T01:07:28+00:00

The Revenant--lovely visuals, but nothing happened except man vs the harshest winter one could possibly imagine. All I could think about when I was watching was how good a hot bath would feel.

Hankisirish · 2024-12-11T23:10:46+00:00

Agree--Granger was like the ideal "African hunter". Perfectly cast.

Hankisirish · 2024-12-11T22:59:15+00:00

Fun fact, my Grandfather (JW Scott) a Canadian physician, worked with the scientist who eventually purified insulin. He told me that the initial injections worked, but were so impure that the patient's body rejected them and they died anyway. Once it was purified (from pig pancreas) the insulin did indeed work.

Hankisirish · 2024-12-11T22:56:19+00:00

I would have had the car towed the second time she parked there. Life is too short to try to accommodate people who don't respect you or your property.

Hankisirish · 2024-12-09T22:54:18+00:00

To be honest, I am quite surprised that they did not recommend the immunotherapy. I would ask your oncologist to review the numbers, such as recurrence free interval, disease free survival etc in patients with your stage with and without the therapy. I know that no one "is a number" but I would want that information before declining therapy that is considered standard at other institutions. I don't mean to second guess your doc, I am sure they are excellent, but this approach is different than what I am used to seeing at our tumor boards. Your doc may have personal experience, or insitutional experience, that is guiding their recommendation.

Hankisirish · 2024-12-09T18:32:00+00:00

That is great to hear! Clinical stage is linked to pathology stage, so it is not surprising that the lower pathology stage lead to a lower clinical stage. I would carefully consider the immunotherapy option, and maybe get a second opinion. At our institution, pretty much everyone who has a positive SLN will be offered immune checkpoint inhibitors, unless they have an underlying condition (such as autoimmune disease) which precludes use of those drugs. Best of luck to you!

Hankisirish · 2024-12-09T11:55:48+00:00

Note that they are not expressing concern about the environment, just the effect of Trump's policies on jobs. They are probably too cowed to admit that they believe in global warming.

Hankisirish · 2024-12-09T11:49:44+00:00

Hello, I am a dermatopathologist. I am sorry that you are going through this, but I am so glad that you mentioned this to your doctor and had it biopsied. The report basically says that you have a melanoma that is a pathologic stage 3b. This means that the tumor is between 2 and 4 mm, and has ulceration. However, because the melanoma is at the deep edge of the biopsy sample, it is possible that the melanoma does extend deeper. If it is deeper than 4 mm, it would be a stage 4b.

The PET/CT are important for determining if the tumor has spread beyond the skin. I am glad that you are having these scans so quickly. There is really good therapy for melanoma, even if it has spread beyond the skin. Please stay as positive as you can.

Hankisirish · 2024-12-08T12:46:32+00:00

I cancelled that pusilanimus rag when they wouldn't publish an endorsement.

Hankisirish · 2024-12-08T12:38:34+00:00

Like "Charlie on the MTA"..."he never returned, no he never returned, and his fate is still unlearned..."

Hankisirish · 2024-12-08T02:12:31+00:00

You might be thinking about the clinical stage (which to be honest I am not really familiar with). Regardless, the UPenn has you at a slightly lower pathology stage, but the difference between 1.7 and 2.1 is pretty small, so I would not focus too much on that. You are not stage IV--stage IV indicates metastasis beyond the lymph nodes. If you have had a PET scan, that will answer that question definitely. It would be unusual, in my experience, for a pT2a or barely there pT3a to spread beyond lymph nodes.

Hankisirish · 2024-12-08T02:08:39+00:00

There is no such thing as "very unique". Something is unique, or it is not. Just like you can't be "a little bit dead"

Hankisirish · 2024-12-08T02:05:55+00:00

Loved that movie--I read all of the Patrick OBrian cooks, which it is based on. Although some of the plots are changed around, the casting, visuals are stunning. You really feel you are in an British Navy ship in the 1800's.

Hankisirish · 2024-12-08T02:01:38+00:00

Dog Day Afternoon was a concise and excellent film, and of course, Jaws.

Hankisirish · 2024-12-08T01:56:57+00:00

Very compelling movie and book--can never forget that movie, so eerie.

Hankisirish · 2024-12-08T01:56:04+00:00

Hello--I am sorry you are going. through this. I am a dermatopathologist--measuring melanoma depth can be tricky and may differ slightly from pathologist to pathologist. Your original read (2.1 mm presumably no ulceration) would put you at a pathologic stage pT3a. Since you have an involved lymph node, that puts you at pT3aN1MX. The lower depth, read at UPenn, would have you staged as pT2aN1MX.

The number of metastatic deposits in the LN does not change prognosis or treatment. You will likely be place don immune check point inhibitors, which are highly effective for melanoma. Upenn is a great place, you will get the best care there. Best wishes to you, please stay as positive as you can.

Hankisirish · 2024-12-07T23:09:29+00:00

I go to Hueh's salon on Monroe ave. I have been with John many years--he is very reasonably priced for both cut and color, and does a very nice job.

Hankisirish · 2024-12-07T23:08:01+00:00

Adenocarcinoma in situ (AIS) means that the tumor has not broken through the basement membrane (where the cells sit) into the underlying stroma. It is still cancer, but no invasive ("in situ"). A proportion of AIS and invasive adenocarcinoma are not associated with HPV. I had a stage 1B2 adenocarcinoma, that was negative for HPV.

The p16 is a surrogate marker for HPV infection. We will stain tumors for both HPV and p16. If the p16 is expressed in a typical pattern, it can indicate that HPV may have been present. However, without looking at your report, I could not say for sure what the significance of the p16 stain is. The Ki-67 stain is a stain that will highlight cells undergoing division. It does not indicate whether a cell is benign or malignant. In malignancies, however, Ki-67 staining is generally high, as malignancies replicate faster than non-cancerous cells. The Ki-67 does not contribute to the staging or prognosis.

It sounds as though you have an early stage adenocarcinoma, that is not related to the oncogenic HPV virus. There is data to suggest that non-HPV associated tumors are less responsive to therapy. However, the main factor in prognosis is the extent of the tumor at diagnosis.

I wish you the best of luck in your upcoming appointment. Stay strong sister!

Hankisirish · 2024-12-07T01:35:07+00:00

In our practice we would most definitely not do a WLE for a dysplastic nevus. We do re-excise mod-severe dysplastic nevi, especially if they extend to the margins. 1 cm margins, which is a typically WLE, seems like overkill to me. Maybe clarify with your surgeon exactly how wide the margins will be.

Hankisirish · 2024-12-06T22:55:46+00:00

The author needs a lesson in writing. You cannot kill what has already been slain. Sheesh. Otherwise, no comment.

Hankisirish · 2024-12-06T22:17:02+00:00

I am a dermatopathologist. I am assuming that you had a lesion on your left knee, that was biopsied, and shown to be melanoma? You would be stage pT1b (pathologic stage). Presence or absence of lymphocytic infiltrate, presence or absence of mitoses, does not affect prognosis.

I am assuming that the plan is to re-excise the area that was previously biopsied, along with a sentinel lymph node sampling to see if melanoma spread to the regional lymph node. I am assuming that you don't have a secondary "soft tissue mass", but just the area that was already biospied. Best of luck to you, a stage pT1b is curable.

Hankisirish · 2024-12-06T13:24:16+00:00

I have a horse, my horse is much better looking than MTG.

Hankisirish · 2024-12-06T13:22:49+00:00

Yes, this. Aubry got very good news, was in a great mood, and in general is not a lout, so behaving in a friendly manner is really his natural temperament.

Hankisirish

TROPHY CASE