House – Episode 14 (Season Three): “Insensitive”
Tonight’s episode started well, but seemed to make less sense as the episode went on. Medically, that is. The character relationships and interactions just got better and better as the night progressed. Spoiler and a long narrative (sorry folks) below:
Hannah is a teen-age girl with CIPA (Congenital Insensitivity to Pain and Anhidrosis), a rare condition in which she can not feel pain, hot, or cold. She is also unable to sweat and regulate her body temperature. As the episode begins, Hannah’s mother is rushing her to the hospital emergency room on a snowy night. Hannah had been playing on the ice with some friends and slipped and fell. Her mother is concerned that Hannah may have injured herself, so she wants her to get checked out at the hospital. Unfortunately, they are involved in a serious car accident — Hannah takes a nasty laceration to the leg while her mother is knocked unconscious.
The ER is overcrowded, so Foreman is filling in and treating Hannah, who has purposefully neglected to tell Foreman about her CIPA. House strolls into the room and immediately diagnoses her when she mimics flinching to a painful stimulus, but does it wrong. He decides to admit her and run x-rays, blood tests, and an EEG. He also wants to perform a spinal nerve biopsy, but Cuddy tells him there is no need for a nerve biopsy unless the EEG is abnormal.
Hannah is a very reluctant patient. She is worried about her mother and won’t sit still for the test. House asks Foreman to sedate her, and Foreman tells him that they tried but she fought back and they were afraid of pushing any harder for fear of breaking one of her bones. House decides to take matters into his own hands. He and Hannah have a “whine-off” over whose life is more pitiful (and I think this scene does an excellent job of showing what Hannah’s daily life is like). When Hannah turns around to show House the scars on her buttocks, he injects her with the sedative and they run the EEG. In the end, all the tests are normal.
When Cameron goes to tell Hannah the results, she finds her unresponsive with a temperature of 105° (that’s 40.6°C for you non-Americans). Her temperature is brought back to normal, but there is no clear cause of her fever. A lumbar puncture (spinal tap) was negative, suggesting no meningitis. While there is an elevated bilirubin, the rest of her liver tests are normal. Her urine drug screen is negative. House decides to talk Cuddy into letting him perform the spinal nerve biopsy. Meanwhile, the Young Guns decide that a spinal nerve biopsy is too risky, and they want to find a better way to diagnose Hannah. Chase suggests that if the pain levels are high enough, Hannah may be able to feel some pain after all and pinpoint where the problem is. He recommends that they purposefully overload her pain sensors and monitor what happens. Chase has Hannah alternate her hand between warm water and boiling water while he runs a brain scan. Unfortunately, she is so worried about her mother that she leaves her hand too long in the boiling water and gives herself second degree burns. Foreman tries the next test. He has some bizarre set-up where he is drilling into the skull and injecting some medication into her brain to stimulate pain receptors. It seems to be working as Hannah starts screaming in pain. However, as soon as they unhook her from the machine, she bolts for the door. She was just faking the pain in order to escape because she has developed a full blown paranoia and thinks everyone is out to get out.
Hannah runs to the lobby balcony and threatens to jump off. The team tries to talk her down, but her legs suddenly become numb and lose control and she falls to the lobby below. She now has several broken bones and a concussion in addition to whatever is causing her fever and leg numbness. House suspects some form of nerve disease. HIV and syphilis are suggested, but he points out that all STD tests were negative. He also states that the cause can’t be vascular because her ANA (Anti-Nuclear Antibody) is normal. Cameron suggests thyroid storm (a rare life-threatening condition where the thyroid gland goes into massive overdrive) as the cause. He checks with Cuddy (who is apparently an endocrinologist) but she shoots down that idea.
House wants to proceed with the spinal nerve biopsy. Wilson talks to him in private, accusing House of wanting what’s best for himself, and not what’s best for the patient. House relents and grudgingly allows the Young Guns to perform a much less risky peripheral nerve biopsy. The results show a demyelinating disease that is affecting outside fibers first. (If you think of a nerve as a wire, then myelin is the insulation surrounding the wire. Demyelinating diseases strip this insulation.) House now suspects some sort of metabolic disease. Hearing that Hannah had a headache after visiting her mother in the ICU, he decides that it was an emotional — a guilty — headache and this guilt means that she has a vitamin B12 deficiency. Foreman points out that she received B12 in the ER. House is now concerned about leukemia and the team is ready to start a bone marrow biopsy. Talking to Wilson (and eating his food), House has a sudden realization and stops the biopsy. He rushes her to the OR in a ridiculous scene where he personally opens up her abdomen and stomach to reveal a long tapeworm. This tapeworm led Hannah to become B12 deficient which led to her loss of sensation in her legs. With some B12 replacement, Hannah should be good to go (of course, she’ll still have CIPA).
The mystery was enticing and the ultimate solution was clever and certainly possible, if unrealistic. The rest of the medicine this episode was a mixed bag. It seemed that for every good idea there was a subsequent bad idea. Getting X-rays and blood work on a CIPA patient after an accident (or accidents, as in this case) is logical. The need for an EEG is not quite as clear cut. If there is a question about a seizure or a head injury, then it makes more sense. Remember, the EEG just shows the electrical currents across the brain, it tells nothing about the nerves elsewhere in the body, so Cuddy’s “do the biopsy if the EEG is abnormal” statement makes no sense. And for what it’s worth, sedation will affect the EEG results.
B12 deficiency is a demyelinating condition that causes nerve problems, particularly in the feet and legs. It is known that that nitrous oxide can cause symptoms similar to B12 deficiency, or can worsen symptoms of B12 deficiency in people who already have it. Generally, it is a slow process and symptoms don’t suddenly appear overnight and cause death within a matter of days or hours (I understand that nitrous oxide can make the symptoms appear much more quickly and could explain her leg symptoms, but even this wouldn’t lead to the life or death situation shown here). B12 deficiency is also slow to cure. It takes more than one injection or pill to correct the deficiency, and even then it will take a while for the B12 to work its way into the system. The most marked symptom of B12 deficiency is a macrocytic anemia (an anemia where the red blood cells are larger than normal). All the blood tests they ran on her and no one ever noticed she was anemic or macrocytic? (Yet, House did mention the eosinophila — high levels of eosinophils — which can be a sign of a parasitic infection like a tapeworm. In medical school, we were taught that eosinophila was caused by the “three w’s:” wheezing, worms, and weird diseases.) Tapeworms are documented, if rare, causes cause a B12 deficiency — particularly the fish tapeworm which Hannah has — but again it is a slow process. There is no need to remove the tapeworm emergently and surgically — it’s messy, hard (those guys hold on tight), and has more risks than simply giving her the medication Praziquantel and replacing the B12 while waiting for the worm to die. The surgery is more dramatic, but it doesn’t give results any faster, and it’s a tremendously more risky.
I think Chase’s idea for overloading her system is unlikely to work, but that’s just an educated guess on my part. The kid has suffered multiple painful injuries in her life and has never yet “overloaded” her system. If sitting on a stove didn’t do it, why would boiling water? I really have no idea what Foreman was attempting so I’ll just keep quiet on that one. House’s alleged plan to transplant one of Hannah’s pain-free nerves into his leg is simply science fiction.
Quick mentions: Blood cultures came back to soon (as always). Was it ever mentioned what exactly caused her fever? House’s team could easily have diagnosed a thyroid storm themselves; I’m surprised no one even blinked an eye at his need for a consult. ANA is used to detect certain autoimmune diseases (like Lupus), not vascular ones, and it is not a perfect test. A negative ANA in now way rules out vascular disease. Finally, the OR scene was wrong on many levels. The scrubbing in and sterile technique was laughable. The surgical team’s acquiescence was improbable, and it’s simply not that easy to cut into the stomach and remove a tapeworm.
The interpersonal interactions were the highlight of the episode. House and Cuddy, House and Wilson. Foreman and Wendy. Cameron and Chase. Nearly makes up for the sometimes sloppy medicine.
Tonight’s medical mystery was intriguing and an A-. The solution made medical sense, but was a little over the top, but I’ll still give it another A-. The medicine seemed to equally split between the very good and the very bad, so that averages out to a C. The character interaction/soap opera between the team members was by far the best part of the show and earns an easy A.
The previous House review
A list of all prior House reviews
February 13th, 2007 at 11:55 pm
Maybe I’ve just become skeptical from reading your articles, but the whole nerve thing seemed ridiculous to me too… How can you transplant nerves?
But the whole relationship things developing interest me a lot… I’m really curious to see what’s going to happen. I hope they don’t just downplay everything as a “Valentine’s day special” and nothing ever comes of it.
February 14th, 2007 at 12:01 am
Oh how I love this website, thanks for getting the review up so quickly. I was a bit baffled by this episode until I read your review. The character interactions were definitely the best part of the episode, especially Wilson’s bit about being House’s conscience.
February 14th, 2007 at 12:04 am
But removing a 25-foot tapework is WAAAAY more dramatic.
(p.s. — did anyone else think “Save the Cheerleader…. Save the World….” during this ep?)
February 14th, 2007 at 12:35 am
wouldnt the EEG fit because she oculdve had a head injury from the car accident. Plus house was bitching about how it was all neurological an such the whole time. idk, i am no where near a doctor… but i might be one day.
February 14th, 2007 at 12:46 am
Of course the OR scene was absurd, although I prefer the term “perverse” – House calling for a no. 15 scalpel, the alarmed surgeon exclaiming, “You’re not going to anesthetize her???” and the girl screaming in a way that was *almost* convincing. And then the girl just watches as House extricates that long, long tapeworm – pretty funny!
The whole relationships aspect of the episode seemed a bit laid on thick, IMHO: Cuddy’s blind date, Foreman and the nurse, Cameron and Chase. A little too convenient for my taste, although I liked how Cuddy’s date maintained his dignity with House.
Now we have to wait three weeks for the next episode, about a concert pianist? (I never saw “3 Lbs.,” but didn’t the pilot of that series have to do with a concert violinist?)
February 14th, 2007 at 1:37 am
They contradicted themselves again! In an earlier episode, they mentioned specifically that they couldn’t sedate a patient because it would interfere with the EEG results. (Also, I remember when I had mine that I was admonished NOT TO TAKE ANY MEDICATION AT ALL for at least 24 hours beforehand. Luckily this was *before* I was on meds – one of my current meds (clonazepam) has a really long half-life, and so I’d probably have had to have been off my meds for a few days.)
The tapeworm was pretty cool – but she must have had it for a very long time, musn’t she? I’m more familiar with the type of flea-borne tapeworms that domestic animals get, which are usually pretty much harmless for quite a while – they don’t “eat” enough to have adverse effects on the animal, even the really long ones. (You still want to get rid of them, though, because they *could* start stealing enough nutrients to cause harm to the animal, but de-worming is relatively easy and painless.)
Soap-opera was A++. I am vindicated! Foreman’s nurse girlfriend didn’t completely disappear! I now have hope that wheelchair-doctor isn’t gone, either! And I always love some good Cuddy-House and House-Wilson interaction, and I like Chase best when he’s making ridiculous facial expressions (plus that whole exchange was just brilliant:
Cameron: So, I think we should totally bang.
Chase: Uh…buh..wha?
Cameron: I mean, we did it before, and you’re totally hot, but I don’t actually like you all that much, really.
Chase: o_O *is unsure if he has just been insulted or not*
Cameron: So yeah. Bangin’.
Chase: …microwave pizza?)
I suppose you could concieveably do a nerve transplant, but, uh, not the way House wanted it to work. (Plus, Wilson was right: He’d be on immunosuppressants for life, and if the transplanted nerves were rejected…BADNESS WOULD ENSUE.)
February 14th, 2007 at 3:23 am
I’m not exactly an expert, although I’m vaguely familiar with CIPA (I always knew it as Riley-Day Syndrome, which is why when I recognized the symptoms I expected the girl to have a Jewish name before House brought it up). But one thing that kind of caught my attention… Isn’t the reason why CIPA patients can’t cry the fact that their tear ducts are underdeveloped from lack of use (either that, or simply a side-effect of the condition)? Which means that the tear ducts of a CIPA patient simply shouldn’t work; so she shouldn’t have been able to cry at all in the scene with her mother.
Of course, I could very well be wrong. I know very little about the specific science behind the condition; I’ve just read a couple of books that had a character who had CIPA. So feel free to correct me; I yearn for knowledge, and like a lot of folks I find rare illnesses fascinating.
February 14th, 2007 at 4:15 am
I think it was a bit overcooked valentine’s special. House has always had a thing for Cuddy (remember sperm donors), but her blind date went way overboard with “I want to date that woman” line. He could detect all that in one night? Who is this guy?
They’re turning Chase and Foreman into House, Jr’s gradually. After last week’s “Who calls cops unless?” moment, Chase had another House’ism with “What was the first question?” It didn’t pan out, but I think it’s heading that way. Foreman was shown dining alone in the previous episode. In this episode he breaks up with his girlfriend. We get the point. I don’t know what Cameron is going to turn into. To offer sex like that was bizarre. Cameron’s supposed to be a doll stuffed by grandma, caring till her eyes popped out. That was just too cold.
I like the House-Wilson moments most. Except for tonight’s “Wilson’s so annoying.” line.
February 14th, 2007 at 6:48 am
I think the whole basis behind the CameronXChase thing is the fact that Jesse Spencer and Jennifer Morrison are actually engaged..
February 14th, 2007 at 7:34 am
“Wilson’s so annoying” was one of the best lines in the episode, IMO. This was House’s way of acknowledging that Wilson was right and he was wrong.
February 14th, 2007 at 8:09 am
classic case of comic-book syndrome, the patient/bad guy is completely absorbing everything we can throw at them, let’s throw more because certainly we’ll overload them!
February 14th, 2007 at 8:54 am
Official Comment
Aaron,
I was thinking the same thing as I was typing up the review last night. All they needed to do was shock her with some massive voltage and it would have been perfect. Maybe that was Cameron’s part of the plan…
February 14th, 2007 at 9:47 am
I like the way House is being the insensitive him again. A little bit of character development in a series like this is fine by me, but the excessive story telling like in ‘One Day, One Room’ didn’t suit him. We love House for being a jerk, not for being a weak guy with a bad youth. I did however like the ‘Wilson’s annoying’ line. :)
The way House rushed into OR to get the worm out was almost as silly as last week’s OR scene. They shouldn’t do such nonsense.
February 14th, 2007 at 10:02 am
Cheers to the writers, producers, etc. They could be listening to us.
Nice attention to NJ details. Accident location Kingston is just north of Princeton, and there is a canal.
The non-brutal-honesty qualities of House are back, along with his Wilson friendship…good stuff.
The three week wait for the next ep, probably network and numbers, oh well.
February 14th, 2007 at 10:17 am
I know this question is unrelated to this episode, but I’m hoping you will know the answer anyway. Has it ever been sarcoidosis on House? My roommate and I noticed the constant mention of it a while ago (being nonmedical people, it took us some time to recognize it), and now react whenever it’s first mentioned in an episode (and it’s been mentioned in EVERY episode since we noticed it). We’re waiting expectantly for when it IS sarcoidosis. Did we miss this episode before we were aware of what has now become an in-joke for us?
Sorry if this comment is a bit jumbled. It’s early morning and I haven’t had my coffee yet. But at least I don’t have sarcoidosis!
February 14th, 2007 at 10:52 am
Official Comment
tizercat,
Looking though my notes, I don’t see sarcoidosis listed as ever being the diagnosis.
February 14th, 2007 at 11:07 am
Scott,
You repeatedly berate the show for taking some artistic license in returning lab results too soon; performing tests on-the-spot by the House team instead of lab technicians, and barging into OR’s. This is not a documentary, nor an instructional video on how to solve a medical mystery or treat patients to cure specific diseases. Don’t get me wrong, I love the reality check on your blog, I’m on it after every episode, but you must cut the writers some slack here. They are using literary tools to heighten the drama, that’s what you do in fiction, and this is great fiction. Some minor medical misdemeanors do not offend me the least. But please, don’t stop :).
February 14th, 2007 at 11:30 am
This episode was awesome in every way!
I guess they hadn’t forgotten about Foreman’s nurse-friend after all. They were just waiting for the gypsy boy to break it to Foreman that he’s doomed to be alone, before they resurrected her. ;-)
And… who saw House & Cuddy (as a couple) coming?! Man, that whole storyline has so much potential. If only these punks didn’t keep pre-empting House for weeks on end….
February 14th, 2007 at 11:31 am
Abe:
This has been covered at length in the past; basically Scott is doing a strictly medical review of the show. He doesn’t allow “slack” because of that fact. I think you’re confusing Scott’s ratings on the medical side with his actual feelings about an episode. He may really like an episode, but give it low scores on the medicine side.
In other words, he creates a dichotomy in the content of the show between the medical, and the theatrical. He does not allow the two domains to overlap.
The overall ’score’ for an episode is not necessarily an average of the two, either.
February 14th, 2007 at 11:51 am
And that was by far the phoniest plastic tapeworm ever fabricated by a props department. A scolex larger than any whale tapeworm, followed immediately by full-sized proglottids, and House was sluicing the intestinal contents off its length (into the open body cavity, by the way) with no breakage at all. Right up there with the fossils in Jurassic Park.
February 14th, 2007 at 1:39 pm
Scott, is Wikipedia corrrect regarding the current preferred treatment?
“Treatment
Praziquantel and niclosamide are historical treatments that should no longer be used as first line therapy in developed countries; they result in destruction and disintegration of the worm which may make it impossible to confirm that the scolex (head of the worm) has been passed (the only way to confirm cure). Praziquantel or niclosamide should only be used in situations when endoscopy is not available or is not possible.
The preferred treatment for all tapeworm infections is injection of Gastrografin into the duodenum, which causes the worm to detach and be passed whole.”
February 14th, 2007 at 1:45 pm
Thanks X. I guess I should have read more of the commentary in past episodes before I spoke up :).
February 14th, 2007 at 2:00 pm
Official Comment
Karl,
From what I can tell, the wikipedia article is overstating the use of gastrografin. According to a current medical literature search including Medline and recent textbooks, Praziquantel or Niclosamide are still the first line therapy. They are well tolerated by adults and children and have a greater than 95% success rate. While it’s true that the scolex is not always passed, checking the stool for eggs can confirm the success of treatment. No eggs in 1-3 months (depending on the species of tapeworm)is considered a cure.
There was a paper published in 1986 in Lancet, the premier British medical journal, documenting the successful use of Gastrografin to treat tapeworm infections. While it was undeniably successful, that was twenty years ago and if it were really the first line treatment wikipedia is claiming, I should have found it listed more prominently in the literature — instead I found Praziquantel and Niclosamide mentioned in every case.
February 14th, 2007 at 2:15 pm
This is possibly the most enjoyable (and disturbing) episode of House I’ve watched this far. And Scott, great review! I’ll never tire of saying this (and I don’t expect you to tire of hearing it either LoL)
I’ve been doing the Central Nervous System for the past 3 months in Physiology and when I learned about CIPA, I imagined it to be a very distressing condition. That scene with the girl’s scalded hands, the teetering stand from the second floor and that sick smile she gave Foreman when he unhooked her from that thingamajig – I felt that the writers did a top-hole job bringing that sort of distress on-screen. Imagine having to raise a child with CIPA.
I went ‘huh’ at the nerve transplant scheme. Forgive me if I seem so obviously uninformed but – to replace someone’s own sensory nerves with non-conducting ones, won’t it be easier to just cut it?
February 14th, 2007 at 2:59 pm
I missed the episode last night, so I’m very grateful for your review and summary! Thanks so much. :)
February 14th, 2007 at 4:06 pm
I enjoyed the episode. You do have to question if they’d let a patient watch in progress as they slice open her abdomen though, that part I wasn’t buying. Granted it wouldn’t hurt her, but still, I don’t think most people want to see their own viscera being worked on.
I did enjoy Cuddy at the restaurant, that part was good. House at the window made me laugh.
February 14th, 2007 at 5:36 pm
While (even) I did realize that some parts of the medicine were just laughable, I’ve had so many laughs and heureka-experiences this epise that enjoyed it as much as none since – well – season 2 I’d say.
The scene in the OR – while medically laughable – was just hilarious.
“Aaah! AAAAAHHH!”
“We’re not buying it”
“Okay”
*fishes tapeworm out of conscious girls cut-open stomach*
Nurse: (takes cellphone out) *click*!!!
Also, the “who has the most miserable life”-contest between House and Hannah was just cool!
“I still got the scars from when I sat on the stove”
“Oh boo hoo!”
“Wanna see them?” (*reveals her butt*)
House: *takes out syringe and it and injects her in same*
Such golden House-moments!
I laughed so loud – I nearly woke the neighbours when she took that picture.
Considering the (albeit mostly evil) laughs I got out of this, this was an absolute classic!
Cameron’s decision that for now she just wants to have sex with the guy she “did” before when she was on drugs was just a jar-dropper. And it was perfectly deliviered. In short: “Wanna f**k?”
“What if I think this question is inappropriate?”
“Then not.”
“Okay – I don’t think it’s inappropriate.”
Also, the clues as to House having some sort of (unconscious? mostly it seems) longing for Cuddy – Wasn’t that what we’ve all been waiting for? And btw, I think Cuddy got one of the best speeches pertaining to “Sorry, it’s not gonna work” ever.
Best “drama” moment: “Are you sure? Are you SURE you’re the one to be making that call?” – House does have a conscious.
As I said: An absolute classic considering the laughs, awkward moments and jar-droppers! That’s what House ought to be!
February 14th, 2007 at 6:58 pm
I have a question regarding guilt as a symptom of B-12 deficiency. I have pernicious anemia and I hadn’t heard that before…I always assumed the guilt was a result of being Catholic…
On another note, I love your site and constantly refer my friends to it. I also have lupus, which makes watching House with other people very interesting- they always look at me every time one of the doctors mentions lupus and usually ask, so is that going to happen to you? (I hope not!) So I send them here for a reality check…and I admit it helps me at times as well…
Thanks for all your work on the site.
February 14th, 2007 at 7:21 pm
When Foreman said, “It’s gotta be 25 feet long,” House said, “Dammit. The world record’s over 60.”
Is that true? Was there a 60-foot worm pulled out of a person?
February 14th, 2007 at 7:36 pm
From Michael.
2.14.07.
Foreman’s getting some!!(or at least his character’s explored more in depth finally). Been a fan of your reviews for 3 weeks or so. Got a question outside of the show review for ya, doc.
Monday night I had a basic physio lab on frog leg nerve and action potential. It was a simulation carried out on lap tops and CD roms. We actually didn’t need to double pithed the frog, lol. Our instructor mentioned caffeine tolerance in relations with stimulation. What’s the exact relationship here? How do coffee drinkers’ response to stimulus get detered?
2ndly, why do people get sugar crash? Is it d/t all the ATP usage during sugar high? How can I explain it to others in layman’s term?
TIA doc,
Michael.
February 14th, 2007 at 8:00 pm
Dave, you are so right. I had to dissect my first frog in class today, and let me tell you – not pleasant.
My favorite part was when House and Hannah were having their “whine-off.” I had no idea life without pain could be so difficult. This was a great episode, but I can’t stand having to wait 3 weeks for the next one!
I really enjoy your reviews, Scott. While I’m watching the show, I feel like I’m getting it, but when I think about it later I have no idea what happened. Your reviews sort of clear things up for me. Just wanted to say thanks!
February 14th, 2007 at 9:10 pm
I just have a question about the whole “let’s-slice-into-the-patient-while-she’s-still-conscious” thing…
From what little I know of surgery, I was under the impression that in the rare case that a person wakes up from anaesthesia during an operation, the only way the surgeons know that their patient is awake, since the patient is still affected by a paralytic and can’t move, is that as the patient regains consciousness, his blood pressure rises and he begins to bleed excessively. If House were to simply slice into his patient and begin rooting around inside her abdomen without putting her under, wouldn’t she bleed out?
I may be entirely wrong, since pretty much everything I currently know about medicine comes from my high school bio class (although I would like to be a doctor someday), but it was just a question which came to me as I watched the episode, and I wanted to see if you could answer it for me.
February 14th, 2007 at 9:15 pm
tizercat,
My family and I had an in-joke where “vasculitis” was mentioned almost every episode in the first and part of the second season. It still shows up occasionally. We used to wait for it through the whole episode and cheer when it was said.
I wish they would have a patient with vasculitis… because every symptom that every other patient on House has had apparently matches vasculitis symptoms, so a patient with vasculitis in theory should be really interesting..?
February 14th, 2007 at 9:56 pm
A few episodes back Cuddy repeatedly told House “you owe me”, I think we’ll be hearing that again.
February 14th, 2007 at 10:19 pm
They couldn’t see the tapeworm on any x-rays?
February 15th, 2007 at 12:22 am
I’m with John, here. It’s hard not to see a nod to Heroes here when one show has a blonde teenage girl who cannot be hurt and the other features a blonde teenage girl who feels no pain. In fact they look so similar there were a couple of scenes where I was wondering if it was the same actress.
February 15th, 2007 at 1:51 am
To John–Though I recognized the actress, I thought she looked like Hayden Panettiere (”the cheerleader”) in this episode as well.
February 15th, 2007 at 10:16 am
Well, ER did CIPA already this season. (And ER’s medicine is usually top-notch.) I wish these things didn’t run in waves like that. (Not only do things run in waves, so do actors. Cuddy’s date has a recurring gig on Studio 60 on the Sunset Strip so you know right away he can’t get a job as a regular on House.)
I think the complete disregard for sterility in the OR is terrible. It’s not some obscure thing only doctors know. Every other TV show gets masks and scrubbing right (or close to it). They’re not breaking some minor detail of protocol, they’re breathing into an open body. I keep thinking, “So what if he cures her? She’ll die of the post-op sepsis.” And I’m not a medical professional.
The fact that someone used a cell phone in the OR was even worse, because you expect the people who aren’t part of House’s team to behave more properly. Cell phones: Not sterile.
February 15th, 2007 at 10:17 am
Oh, one other thing: Didn’t we already have a tapeworm episode? I’m thinking season 1.
And yeah, I totally thought Heroes.
February 15th, 2007 at 11:36 am
I’ve been waiting for the House/Cuddy thing to develop, since his persistent interest in (and mocking of) her attempts at a sex life (or getting pregnant, or whatever) struck me quite a while ago. But please, please writers, don’t just make this another plot twist. I’m relatively bored of the “Sam and Diane” phenomenon (or Rachel and Ross), where two characters fall in love, and then the writers don’t know what to do with it, so have them fall out of love, have us sit through multiple episodes or seasons of back-and-forth, etc. etc. It’s trite — and I worry that they’re already setting us up for an extended story arc here.
I’d just as soon have that develop at the very end of the series, whenever that is, so they can either leave us with the belief/hope that Cuddy and House actually DO care about each other, or . . . well, or address and resolve it.
I really hope they don’t just use this as one more story arc (like the one with Sela Ward) that ends up with everything back at status quo. I’m already sort of bored with that. Either focus on self-contained stories, or have things that matter actually happen to the characters. As it is, they seem to want it both ways — significant things do happen (House is ordered to fire one of the Young Guns, House’s leg becomes pain-free, Chase and Cameron hook up) . . . and then several episodes later everything’s back to the way it was.
Anyway. Sorry to rant. Great episode too. And I like how House really wanted to rip on Cuddy’s date, and had to admit that he seemed like a pretty good guy. You could tell how frustrated he was by that!
February 15th, 2007 at 12:36 pm
I loved the interaction between the main characters, This was the best “House” in a while.
February 15th, 2007 at 2:16 pm
Nick asked “Is that true? Was there a 60-foot worm pulled out of a person?”
This bugged me when Foreman mentioned it. No, it’s most likely not true – the fish tapeworm, the longest in humans, generally reaches up to 30 feet (and not usually that). Tapeworms do get longer in other animals, however.
There are a few web sites which claim longer tapeworms in humans, but I haven’t found any that provide documentation or appear reliable. 37 feet, perhaps. I think Guiness does track this record, but I don’t have a copy. Since the tapeworm normally hangs fairly linearly – it can’t fold back or bunch up in most circumstances – I’d suggest caution towards tales of one much longer than the intestinal tract itself.
February 15th, 2007 at 2:31 pm
Can someone fill in the list from the House/CIPA episode?
Guilt – B12
Depression – Pain
Paranoia – ???
Is this new research? or just more House-isms?
Thanks!
February 15th, 2007 at 2:49 pm
You know as much as I love this show and realize that the medicine in it is more often than not bad, atleast the way House practices it, the “surgery” scene really bugged me. First of all, she’s going to have a really nasty scar for something that could’ve been taken care of through meds and whether she can feel pain or not isn’t a good reason to slice into her without knocking her out (imagine it was YOUR kid!) and then there’s the whole not scrubbing in/un clean thing. Great, got rid of the tape worm now to cure her staph-infection I guess.
Of course House won’t get any repercussions from this, but I suspect why such a world-class and highly respected doctor dosen’t live extravagently is because of astronomical mal-practice premiums. But, then again, pulling a few-yard long tapeworm out of a young-girl is far more dramatic than delivering her some pills.
This was a dittoing of their first case solution too.
February 15th, 2007 at 7:21 pm
Hi Scott, first time I am writing but I actually like your review of the show. I am posting just to point out that you can have a B12 deficiency without anemia or even macrocytosis. In some patients the first symptom is the neurological/psychiatric ones. In some of these patients the blood test only will show subtle macrocytosis if any; the kind the most of doctors will discard as a normal value. I am looking for the papers to support these claims; I know I have them somewhere. Anyway these one maybe will be enough http://www.annals.org/cgi/content/full/124/3/338 I will put more when I found them.
In these one I am not that sure but, Is not the CIPA enough to explain the fever?
Keep the good work you are doing great (Sorry if my post is hard to read I am not a English native speaker.
February 15th, 2007 at 11:15 pm
to: tizercat
my brother and I noticed repeated mention of sarcoidosis and have wondered if it would ever appear as the real thing. I thought we were mistaken because everyone else noticed a lot of lupus.
I loved the HouseWilson scenes and think that they have the coolest relationship, I’d much rather have that explored than the HouseCuddy relationship.
February 16th, 2007 at 1:58 pm
There were so many good lines in this one – but I think my favorite was House asking if they expected him to catch the girl when she was threatening to jump.
Also, I hadn’t thought about it before. IS House capable of just watching Wilson eat without joining in? It’s like some kind of compulsion.
What annoyed me, though, was when the girl hung up on the 911 operator. Speaking as one myself, PLEASE DON’T DO THAT. I HATE it when people hang up on me before I’m done with them. :(
February 16th, 2007 at 4:02 pm
Nerve transplant maybe:
http://www.medpagetoday.com/Surgery/GeneralSurgery/tb/2172
but House’s plan (as least as deduced by Wilson) to use a donor biopsy speciment to grow a nerve unable to sense pain?!!? If his pain is neurogenic, why not have an autologous transplant i.e. one of his own nerves? At least there would be no need for lifelong immunosuppression.
February 16th, 2007 at 7:50 pm
abe,
“You repeatedly berate the show for taking some artistic license in returning lab results too soon; performing tests on-the-spot by the House team instead of lab technicians”
It bugs me too, but that’t only because I have a personal bias towards the lab and there is no love for the lab on this show. Also, laboratory technologist (or Medical Technologist or Clinical Laboratory Scientist)not technician is who you are meaning, and there is a difference.
February 17th, 2007 at 12:06 am
Here’s an interesting case report for those who have an NYT subscription: http://www.nytimes.com/2006/08/08/health/08case.html?ex=1171861200&en=79245befe777d092&ei=5070
February 17th, 2007 at 7:23 pm
Thank you Scott for your fine commentary. I, too, come to read it after each House episode.
I’m glad that the episodes are “back to normal” after that awful Tritter arc. I really enjoyed the interactions among the characters: finally the writers are giving us a little more of that (I’m especially referring to the interactions of the Young Guns among themselves). However, the recent trend of ludicrous O.R. scenes is bothering me. I mean, it’s a TV show and everything, I have to suspend my disbelief, etcetera. But come on, this was unbelievable and an insult to the watchers’ intelligence. The moment when the surgeon takes out her cellphone to take a photo of the tapeworm was just foolish – Aren’t cellphones prohibited in such crucial parts of a hospital as an O.R.?
Anyway, as I said, the “soap opera” part of House is getting better and better, in my opinion, and that’s good!
Cheers
Rick
February 18th, 2007 at 12:15 pm
I’ve been following this site for awhile now and I find the comments to be rather
interesting and informative regarding all episodes thus far.
It’s prime time entertainment at it’s best…and for the most
part, whether it’s right or wrong in the diagnosis of any weekly
patient, it’s pretty much a love story wrapped around a weekly medical
mystery.
House always seems to come out on top and that’s what the premise
of the series really seems to be all about. Let’s face it…
most that follow the show can expect to witness Hugh Laurie’s character
come to a medical conclusion over a plate of french fries
at about “minute 32″ in the show, leaving another 5 to conclude
with a heart-felt tune to finish off the episode…then we witness
the cartoon clip and the overtone…”That’s Some Bad Hat Harry”…
and then we switch to Boston Legal.
I like reading the reviews here and I also love the technical
forays into the medical doubts and impossibilities.
That’s what makes the show what it is. Of course nothing is carved in
stone…if it was and the show was judged on this basis, it would
have been cancelled after the first episode.
We have a British actor that can seamlessly portray himself as
a medical specialist and continue to garner rave reviews and continue
on week by week, (depending on the pre-emptiveness of the network)?…
to entertain those of us that are fans of the genre.
I wonder if we were to go back a few years and start critiqueing a show
show such as St. Elsewhere for example…surely that series could be dismissed
in a heartbeat, simply because of Howie(Deal or No Deal)Mandel and his
mis-diagnosis of pretty much every patient that came through the door?
…plus the fact that Doctor Craig witnessed his character on screen
as wearing a rubber glove on his head. This is what made tv dramas great
not only then, but now.
This series is entertainment at it’s best simply because of the
character it portrays. I say we embrace it for what it is, because in
all fairness, I think it’s got about 2 more years under it’s belt maximum
and then the majority of us, (myself included), will be “boo-hooing” because
it was taken off the air for reasons unbeknownst to any of us.
My take on the show…A+ all the way!…yeah, some episodes are better
than others, but what series on television today and days past don’t and
didn’t have the same quality?
What I’d like to see is a crossover. House meets Denny Crane or something
of that nature. Anyone recall the St. Eligius clan hooking up with Carla
and Co. at Cheers many moons ago?…Now that’s network television
at it’s best!!!…hahahaha
Thanks
Kim
February 19th, 2007 at 11:01 pm
Kim, I agree with you. Just never had the energy to type all that stuff here.
House did mention Jack Bauer once, but Denny Crane saving House’s butt legally could be…
We fans are a minority. We are or want to be like House. Tough road though.
As long as House dosen’t wake up in Black Adder, like Bob Newhart did…
February 22nd, 2007 at 1:46 pm
Diphylobothrium latum (”Fish Tapeworm”) can grow over 10m and live for decades.
Praziquantel is the treatment of choice and personally I would be pretty pissed if you treated me any other way (ie. surgery or making me pass a 10m tapeworm in my feces by treating with gastrografin.)Lesson for the day, DON’T EAT SUSHI! (especially if it is made from fresh water fish)
February 24th, 2007 at 6:48 am
In comment #52, Kim mentions the medical drama St. Elsewhere. I don’t know if anyone has pointed this out here before, but the actor David Morse, the infamous Tritter of House, played Doctor Jack Morrison on the earlier show. Oh, irony of ironies!
I haven’t seen St. Elsewhere in almost two decades, but I recall David Morse as Dr. Morrison being a very slightly built, somewhat fragile character. He has certainly morphed into a most imposing specimen since.
March 3rd, 2007 at 12:53 am
I don’t have a specific comment about this episode, but I want to thank Scott for the reviews!
I ran across this site a few months ago and it inspired me to try watching House – I’m constantly bothered by shows that portray my field of expertise (computers) unrealistically, so a show that was at least accurate enough to be respected by a doctor intrigued me.
I’ve been watching the show on my workouts since then, starting with Season 1 Episode 1, and reading the great commentary here afterward. I figure I’m actually learning a tiny bit about medicine, since this site tells me which parts of the show to believe…
Anyway, I finally caught up and can watch the next episode along with the rest of you on Tuesday. Thanks for the entertainment and food for thought!
March 7th, 2007 at 10:35 pm
Scott, why don’t you write a draft episode, or a medical plot at least, post it here for feedback, and throw it over to Shore et al?
March 25th, 2007 at 11:48 pm
I found the episode pretty interesting, but a lot of parts were pretty unbelievable. One, that girl is old for a CIPA kid. Most kids I thought did not leave that long. Also, most CIPA people ahve their teeth removed so as not to harm themselves. I know a child who has CIPA. His website is http://www.helproberto.com. The website is nice and explains everything down to earth so that people don’t get a skewed view of CIPA patient.
April 19th, 2007 at 10:50 pm
Obviously, she only survived because of her extremely protective mother and her brilliant tricks to compensate for not knowing when to exercise her bodily functions. Also, “most CIPA people ahve [sic] their teeth removed”
Personally, I think if he’s willing to try the transplant, he should have been desperate enough at the end of the Tritter arc to have the pain centre of his brain surgically removed, although replacing bits of the brain and spinal cord should be easier to hide from the immune system than a heart transplant without resorting to compromisation because of the blood/brain barrier.
May 12th, 2007 at 3:59 pm
u sed that the eeg was unnecessary and diddnt know why it was requested or why cuddy even mentioned it. well house wanted the nerve and maby he predicted cuddys reaction for the request and ordered the eeg as a just incase way of getting the nerve biopsy. also the only reason why cuddy would say if the eeg is abnormal was probably like anything els she does was simply to humor house in order to avoid an argument by telling him that he was absolutely rong about something. sry about my typing and all i am just a bit rushed
May 23rd, 2007 at 5:43 am
I’ve been studying hematology in my first year in medical school and I’ve constantly thought back to this episode of House in order to help me remember the weird D. latum parasite as a cause of B12 deficiency.
Here’s a thought as to why she didn’t have a macrocytic anemia.
If she had sufficient amounts of folate in her diet, it would correct anemia, but B12’s other function involved in breaking down methylmalonyl CoA to succinyl CoA would not be corrected. A buildup of methylmalonyl CoA is somehow involved with grey matter myelination.
That’s why it is so important to distinguish between a folate and B12 deficiency! If you give folate, the blood counts will normalize, but it doesn’t necessarily make the problem better.
June 5th, 2007 at 5:24 pm
Hey, thanks for that comment for us non-Americans… I love your reviews!
Greetings from Germany, Frieda
November 11th, 2007 at 9:41 am
Just a short add to what fun and notmysecondopinion already said: The Cobalamin (vitB12) deficiency only shows up with an macrocyte, hyperchromatic anaemia in 50% of all patients with vitB12 deficiency.
So it’s said in the Claasen, the standard literature for internal medicine in germany.
It’s also said, that the damages of the spinal cord (like the numb legg in this episode might be a result of it) caused by B12 deficiency might be irreversible (neorons are very allergic to a loss of there myelinsheds and atrophys if the axon itself is harmed, and axons normally cant regenerate), but i dont know if the numb legg is a result of a peripheral nerve damage (and its not said in the episode as I remember).
December 17th, 2007 at 9:21 am
I just watched this episode on AXN Asia. The ‘get away’ and cellphone scenes were hilarious. To the earlier Nick: that record-setting tapeworm was found in a whale.
January 28th, 2008 at 11:22 pm
I thought House’s desparate need for the consultation with the thyroid storm was made obvious in the show – he wanted to bother Cuddy.
April 16th, 2008 at 6:26 pm
To John, Marionette and Shanna,
The actress that plays Hanna is actually Mika Boorem. I just lost a bet with my roomate since I thought it was Hayden Panettiere too (they look so much alike!). Should see wikipedia before I bet!
Cheers,
mar
July 17th, 2008 at 7:28 am
I’m sorry, I don’t usually comment here, but before I even read the rest of the comments, I have to say that SquishyCat’s summary of the Cameron-Chase dialogue way back on day one was the best thing I have read in at least the last seven minutes.
Replicated for people who have no idea what I’m talking about and don’t want to search for it:
“I like Chase best when he’s making ridiculous facial expressions, plus that whole exchange was just brilliant:
Cameron: So, I think we should totally bang.
Chase: Uh…buh..wha?
Cameron: I mean, we did it before, and you’re totally hot, but I don’t actually like you all that much, really.
Chase: o_O *is unsure if he has just been insulted or not*
Cameron: So yeah. Bangin’.
Chase: …microwave pizza?”
Disclaimer: I’m sleep deprived and may think things are funnier than they are. But I thought it was awesome.
August 25th, 2008 at 9:10 am
B12 deficiency caused by fish tapeworms isn´t as uncommon as you suggest.
October 27th, 2008 at 4:03 am
I think the writers / producers keep bringing up sarcoidosis just to hear Jesse Spencer (Chase) say it with an Australian accent :-)
November 14th, 2008 at 12:53 pm
tizercat, it used to be lupus was brought up in every episode, now sarcoidosis is taking the lead. there was a bonus feature on one of the season DVD’s that had a montage of all the mentions of lupus – pretty funny
November 26th, 2008 at 6:06 pm
Yeah matt, they made a slight reference to it in one of the episodes of season 3 I think. When Lupus was shot down, House says “yeah, it’s never lupus.” I laughed and no one understood why I was laughing.
I love this site.
December 28th, 2008 at 8:55 am
I just wanted to note, that sarcoidosis case was in “3 stories” in 1st season, I guess.
March 19th, 2009 at 9:07 am
okay. this is the most disgusting episode of house ever. the OR scene is funny and disgusting. the dialogue is hilarious, but a 25 ft. tapeworm just takes it too far. the rest of the episode is great, but this is just revolting
April 18th, 2009 at 9:04 pm
I also agree that the final scene in the E.R. was completely ridiculous and interesting enough for one of the nurses to take her cell phone out and take a picture (something I’m sure the ethical committee would not be pleased with). I remember reading an article a few years back about a doctor loosing their license for taking a picture of a patients tattoo during surgery. The tattoo was located on the patients penis, which is what stirred up the controversy. So next time your in the O.R. and feel like taking a picture, take a mental note.
July 15th, 2009 at 4:55 pm
I’m watching every season in order, and this may be my favorite episode so far. Okay, the medicine was bad, but… it just wouldn’t have been the same without the tapeworm scene! Ridiculous, but awesome. And the scene where House and Hannah debate over who has it worse has to be the best House back-and-forth ever.
July 18th, 2009 at 2:02 am
This episode was horrible. This girl was barely a minor and yet was forced to undergo all those tests just because House wanted to cure his pain. Disgusting.
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