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BJessee

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    Physician Assistant Student

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  1. Ran into a single patient who was diagnosed with this while I was doing my surgical rotation. My preceptor (general surgeon of 30 years) and I were both entirely unfamiliar with it until when we received the biopsy results. I will paste the UpToDate summary of the topic below: SUMMARY AND RECOMMENDATIONS ●Castleman disease (CD) describes a heterogeneous group of lymphoproliferative disorders that share common histopathologic features and abnormal proliferation of morphologically benign lymphocytes. CD is classified based on the number of lymph node regions with enlarged lymph nodes. Unicentric CD (UCD) involves one or more lymph node(s) in a single region, while multicentric CD (MCD) involves multiple lymph node sites and is subclassified into human herpesvirus 8 (HHV-8)-associated MCD and HHV-8-negative/idiopathic MCD. ●UCD is most often an isolated lymphoproliferative disorder of young adults. Patients are commonly asymptomatic and are brought to clinical attention when an enlarged lymph node is noted on physical examination or imaging studies. Most lesions are in the mediastinum, but UCD can present in any lymph node location. Laboratory and clinical abnormalities are seen in less than 25 percent of cases. (See 'Signs and symptoms' above.) ●UCD should be suspected in the setting of a single persistently enlarged lymph node associated with moderate to intense post-contrast enhancement on computed tomography (CT). 18F-fluorodeoxyglucose positron emission tomography (FDG PET) should establish that the disease is limited to a single site. (See 'Imaging' above.) ●The diagnosis is made upon pathologic review of a biopsy of involved tissue, typically an excisional biopsy of a lymph node. Biopsy should demonstrate histopathologic features consistent with the hyaline vascular, plasma cell, or mixed histopathologic subtypes, though the clinical utility of these histopathologic subtypes is unclear. HHV-8 testing via LANA-1 should be performed and be negative in all cases of UCD. (See 'Pathology' above.) ●The evaluation should exclude other disorders that can present with a solitary enlarged lymph node that displays CD-like histopathologic features. (See 'Differential diagnosis' above.) ●For most patients, we recommend complete excisional resection of the involved lymph node rather than core biopsy or incomplete resection (algorithm 1) (Grade 1C). Complete resection is curative in the majority of patients. If the involved lymph node cannot be completely removed because of its anatomic location, we proceed with systemic therapy to reduce mass size followed by surgical resection. Options for systemic therapy include treatments utilized for HHV-8-negative/idiopathic MCD. Localized radiation therapy has a relatively limited role. (See 'Treatment' above and "HHV-8-negative/idiopathic multicentric Castleman disease", section on 'Classes of therapies'.) ●After resection, patients should be evaluated to determine the disease response to treatment and should be followed longitudinally for relapse and complications. Follow-up generally includes annual imaging and laboratory studies
  2. I am looking for some insight from any PA practicing in outpatient psychiatry, especially is TN or VA I heard from a colleague that there has been some issue with reimbursement in the outpatient psychiatry realm that is specific to PA services I wondered if anyone currently practicing in this specialty or anyone with knowledge about the situation could weigh in. Are PAs reimbursed at the normal rate or at a decreased rate? Are there discrepancies between reimbursement for medicare/Medicaid and commercial insurers? Thank you all in advance!
  3. Glad you guys liked it! It's definitely important to settle in before school gets started. If there is anything else you need just let us know!
  4. I am originally from the area and have been living in Jonesborough (about 20 mins away) for many years. Is there anything specific you are looking for? When the weather is better there are a lot of good outdoor things to try but that won't do you any good now :/ There are a lot of good restaurants. Fast food= Pal's BBQ= Southern Craft or Firehouse Mexican= Amigo's or El Charolais Japanese= Yamato's or Moto's If you like theater the Barter in Abingdon is usually great (about 1hr away)
  5. I haven't heard anything about a Facebook group yet but I think it would be a good idea.
  6. Received an e-mail today with information about background checks etc...
  7. There is no way to be certain, they use rolling admissions and if you look back through this forum it seems to me that they have had about one interview day each month since June. The most recent was late in august. It is possible that they are saving some seats for a September interview, but I'd suggest contacting them directly.
  8. I’m sure they’re waiting until they have the class filled. I look forward to getting everything finalized and starting class! I live in the area (about 20 mins from campus), so if there is anything I can help you guys with just let me know!
  9. I haven't heard anything since I got my acceptance e-mail on 7/27. I did e-mail Jenni Duran several weeks after that and she told me that they should be contacting people soon. I hope I hear something soon. I assumed after I made the payment to reserve my seat that I would get some kind of confirmation but not luck. Have you heard anything? PS: Congratulations on being accepted!
  10. Interviewed on Jul 25. Acceptance e-mail on Jul 27th! Super laid back interview process with awesome staff. I have not heard about how many seats have been filled and how many are left open. Last communication I got was that the program would be contacting the students who have been accepted and made their deposits within the next two weeks. Good luck to all!
  11. I just wanted to start a thread for the upcoming Milligan PA class beginning in 2019. Any general information can be shared and questions about the program or the area are welcome!
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