House — Episode 5 (Season 5): “Lucky Thirteen”
This week’s episode of House was definitely a character episode focusing on Dr. Hadley (Dr. Thirteen, that is), and it showed in the jumbled mess that was made of the medicine.
Dr. Thirteen picked up Spencer, a girl at a local bar, and brought her back to her apartment for a night of casual sex. As she is washing up afterward, she looks up to see her companion fall off the bed in a tonic clonic seizure. Spencer is rushed to the hospital (Princeton Plainsboro, of course), and admitted to House’s team.
This is Spencer’s first seizure, but her medical history is also significant for several months of severe fatigue as well as a retinal vein occlusion (a blockage in one of the veins of the eye — very unusual in someone of her age) that happened several years ago. The initial differential includes dehydration, drug abuse, some vague neurological problem, or a blood problem. Kutner and Taub suspects blood clots, which they blame on her bone marrow being in “overdrive” and producing too many platelets. Instead of going about it the easy way and checking a blood count — which includes a platelet count — House orders a bone marrow biopsy. Thirteen performs the biopsy, an extremely painful procedure, but the results are normal.
Later as Spencer is being discharged, she starts gasping and the heart monitor shows tachycardia (a rapid heart rate), which ultimately needs defibrillation to control. Drug abuse is the top potential diagnosis again, and House and Foreman search Thirteen’s apartment looking for clues. They find a brown recluse spider, so a spider bite is now a possibility as well. House orders Thirteen to perform a thorough search of Spencer for a spider bite. She finds no bite, but discovers that Spencer has numbness in the skin over her hip. Labs reveal hypokalemia (a low potassium level), which Thirteen believes explains the numbness and heart problem. House tells her that the low potassium indicates a kidney disease. IgA Nephropathy, PSAGN (post sterptococcal acute glomerulonephritis, i.e. kidney damage following a Strep infection), and Renal Tubular Acidosis (RTA) are all suggested, but RTA is the only one House thinks fits (RTA occurs when the kidney don’t acidify the urine like they should and acid builds up elsewhere in the body. There are several types; House is referring to Type I, or distal, RTA). He orders a CT of the kidneys to look for kidney calcifications, a sign of Type I RTA.
The CT must have been positive, because when we next see Spencer, she is in surgery having kidney calcifications removed. As the operation is ending, her oxygen saturation (the percentage of red blood cells in the arteries that are loaded with oxygen) starts to drop precipitously and she requires intubation. A chest x-ray shows normal lungs so the team suspects she suffered some sort of airway collapse, possibly from an autoimmune disease or some form of dystrophy. House has them place her on a treadmill and perform a methacholine challenge (a medication that causes airway narrowing; used to diagnose asthma) to see if they can induce the airway collapse again so they can diagnose it. Meanwhile, Thirteen is re-examining the x-rays and sees some subtle signs of a flattened diaphragm (a sign that the lung in question in over-inflated), which she interprets to indicate a lung cyst. She rushes to catch up with the rest of the team because she believes placing Spencer on a treadmill will cause her lungs to “explode.”
Thirteen was correct. When she arrives, Spencer is on the ground grasping for breath. Thirteen notes the deviated trachea and realizes Spencer has a tension pneumothorax (from a ruptured lung cyst) and performs a needle thoracostomy to correct the problem. The team obtains a chest CT which shows many other lung cysts. The differential now consists of amyloidosis and pulmonary fibrosis. A cyst is biopsied and shows smooth muscle cells. This is a sign of LAM (lymphangioleiomyomatosis), a progressive and fatal lung disease. When Thirteen breaks the news to Spencer, she notices Spencer is bleeding. A blood count is completely low, which doesn’t fit with LAM. The differential now shifts to include aplastic anemia (the bone marrow stops producing any blood cells), PNH (paroxysmal nocturnal hemoglobinuria), Langerhans Cell Histiocytosis, or mastocytosis. House wants to perform a bone marrow transplant, without killing off Spencer’s own bone marrow first — a definite initiation for graft versus host disease. During a conversation with Thirteen after she gets the consent, he has his weekly “Eureka” moment. Seeing Thirteen chapped lips, he realized that Spencer also has chapped lips; he then realizes that Spencer has never cried, even when told she was going to die, and even when he purposefully exposes her to freshly cut onions. Malfunctioning tear ducts are one of the classic signs of Sjogren’s Syndrome, a type of autoimmune disease. With treatment, Spencer will recover.
Major complaints are in red, minor in blue, nit-picking in green:
While Sjogren’s can be associated with lung cysts, that does not explain away the lung biopsy showing smooth muscle proliferation.
It’s sad when a team of alleged medical geniuses can’t diagnose a tension pneumothorax.
On the other hand, if the pneumothorax is severe enough to cause tracheal deviation and pulmonary collapse, why are there breath sounds? (But then Taub’s a plastic surgeon, maybe he forgot how to use a stethoscope).
What explains the seizure that started the whole episode?
Going straight to bone marrow biopsy is a bad idea. And then forgetting it was normal when discussing all the bone-marrow-influencing diseases later in the episode (aplastic anemia, PNH, etc).
Bone marrow transplant? That came out of nowhere with no supporting diagnosis to explain it, especially the way he wants it done. Remember, her bone marrow biopsy was completely normal at the beginning of the hour.
Kutner and Taub’s “blood clots” diagnosis doesn’t explain anything, except maybe the retinal vein occlusion.
Recent studies show LAM is not as rapidly fatal as initially believed, with many patients living 20+ years after diagnosis.
All that kissing and Thirteen never noticed that Spencer had a severely dry mouth (and would be dry in other significant areas as well).
Brown Recluse Spider bites are hard to miss.
Lung cysts usually show up on x-rays
If Thirteen were properly using a spacer with her steroid inhaler, she wouldn’t have the chapped lips.
The medical mystery was pedestrian (at least by House’s standards), so earns a C-. The final solution of the Sjogren’s is something they should have caught sooner, and contradicts some of the early data. It leaves some important findings unexplained as well. I give it another C-. The medicine was disorganized and all over the place and skipped straight to the zebras, skipping the more common diagnoses and proper tests. It earns a measly D. The non-medical soap opera aspects of this story were good if a little predictable (who couldn’t see that Wilson was stringing House along) and earns a B+.
October 21st, 2008 at 11:32 pm
Wasn’t the episode titled, “Lucky Thirteen”? (Right now, the top of the page says “Lucy.”)
October 21st, 2008 at 11:34 pm
Official Comment
Oops, typo.
October 21st, 2008 at 11:37 pm
As soon as House asked if she had tears I knew it was sjogrens! I’m starting to apply what I’ve learned from watching House all these years!
October 21st, 2008 at 11:42 pm
As for the unexplained seizures, I guess it was possible that after we were made aware that Spencer used 13 to get to House, we were supposed to assume that the seizures were self-induced.
October 21st, 2008 at 11:42 pm
I agree with brown recluse spider bites being hard to miss – in that they’re *ridiculously* hard to miss. Anyone who lives in an area where recluses might potentially live probably got the same litany when they were a kid, but my parents always told me that if your skin started peeling off, you needed a doctor visit pretty fast. Recluse bites practically rot your skin off. It’s pretty gross, and impossible for the doctors to have missed.
Which is why I laughed like a hyena when they said it might be a recluse bite in the show.
October 21st, 2008 at 11:49 pm
I figured the brown recluse spider misdirect was designed to give the viewers the homoerotic girl-on-girl scene of 13 sensually examining the patient. This show used to be better than that.
Kicking myself for not putting Sjogren’s on my list for the game.
October 21st, 2008 at 11:51 pm
Good review. Thanks.
The medicine must be really obviously bad because I found myself asking a lot of the same questions I see in your review. You could tell they couldn’t care less about having it make sense this episode.
I wish House had kept 13 fired. I don’t really feel she adds much to the show and I just don’t care for her one way or the other.
And I agree about Wilson, I saw it coming a mile away too, but I still thoroughly enjoyed it. Having Wilson back to normal makes this show fun to watch again.
October 22nd, 2008 at 12:21 am
I am confused about the chapped lip connection. Were spenser’s lips chapped as a result of Sjogrens? and Thirteen had chapped lips from the inhaler and it was just coincidence that generated the eureka moment?
or
House said they both had a yeast infection as a result of the inhaler. did that cause the dry lips and if so what did that have to do with the final dx?
October 22nd, 2008 at 12:34 am
“All that kissing and Thirteen never noticed that Spencer had a severely dry mouth (and would be dry in other significant areas as well).”
Nobody? Alright, I’ll be the first to say it:
This was hands down the sexiest episode of House EVER.
October 22nd, 2008 at 12:38 am
I don’t have much of a back ground in medicine like you do, but I still enjoy reading your reviews, because they give me a lot of insight into the differences between what happens on House and what happens in real medicine. Keep up the great work!
And I also feel like an idiot for not seeing the Wilson twist coming at the end. I totally believed that Wilson was with the Hooker until House confronted him at the end. It’s great to see Wilson back to his old self though.
October 22nd, 2008 at 12:41 am
Why do you doctors have multiple names for the same disease/disorder?
For example gran mal seizure vs. tonic clonic seizure?
October 22nd, 2008 at 12:50 am
I had my rant about 13’s non-character back at the end of last season, and I’m feeling validated (unfortunately).
Well, at least the show hasn’t completely descended into… into… boy I don’t even want to say it… Gray’s… Gray’s… I’m sorry I can’t say it. Man we need a big medical turn-around, this season has been pretty much all goose-eggs!
October 22nd, 2008 at 12:51 am
I didn’t mind the P.I. this week either because he wasn’t involved in the main plot with the main characters and was just used as a minor character foil for House’s views.
I made a joke about the other areas dryness too. So it’s good to see that I can make a medical deduction like a genuine doctor and I’m not just a perv.
This makes me two for two in stupid joke diagnoses as last week I made a SARS comment as soon as the Chinese-American young woman coughed in House’s face. (Being from Toronto helped with that one.) But I’m still zero for ten-thousand in deducing anything about the real medical mysteries.
October 22nd, 2008 at 1:10 am
For those of us without a medical background, it was still a good ep. :) I like that they were able to get away with sensational hot-girl-on-girl-action without sacrificing the humanity of the characters. I’m glad to see Thirteen is developing into a character independent of the original ducklings’ paradigms, though she’s still not a terribly believable human being.
October 22nd, 2008 at 1:34 am
Brown Recluse? Not likely… ‘South Central Midwest’ seems to be the accepted region for finding those… but
“In some states such as California, unsubstantiated reports concerning recluse spider bites have taken on the status of “urban legend” leading to overdiagnosis and, therefore, inappropriate treatment.”
http://dermatology.cdlib.org/DOJvol5num2/special/recluse.html
October 22nd, 2008 at 1:59 am
O.O There are spiders that can peel your skin off? Oh gawd, I did so not need to know that!!
[Everyone *always* told me that poisonous critters stopped just north of Drumheller so i didn't need to worry. I kept saying there were redbacks in the barn but ohhh no, I was just being paranoid... until one moved into my parka!] …i really hate spiders.
October 22nd, 2008 at 2:40 am
You think that someone (her eye doc?) would have noticed the dry eyes and at least gave her some eye drops….I might stop watching House soon, since they’ve started to do what I call “ER Syndrome” and throw all realism out the window and just go for flashy television, forgetting their audience is actually intelligent. Granted House has always been “out there” in terms of medical realism, but this season and last are getting insanely ridiculous.
I guess there medical consultants are drunk or something, since they’re not helping much these days….
October 22nd, 2008 at 3:21 am
I actually like 13, and wish they weren’t pushing her out the door so fast. You’re at risk for Huntingdon’s! You’ve got Huntingdon’s! You’ve got a really high repeat count! You’re in a self-destruction spiral! You’re fired!
Okay, she’s unfired, but she’s obviously on thin ice.
New Orleans native and life-long New Orleanian until Katrina. (I *will* be able to return one day!) I also immediately thought that brown recluse bite was ridiculous. 1) Way too far north. Brown recluses like the cold about as much as I do. (i.e. not at all) New Jersey is way too far north.
2) Brown recluses are well-named. They don’t like being disturbed. Unless they took a break to move an old desk or some such, I don’t see it happening.
3) To not feel the bite would mean that she was one of the few people that have a resistance to recluse venom, which would make it a lot less likely for her to have a severe reaction. If she is so resistant that she has no skin necrosis from the bite, (Which should have been easy to find.) it’s even less likely she’d have a life-threatening reaction.
There’s either a huge continuity gap in the show, a really strange line, or Foreman is the world’s worst liar.
Here’s the order of events we see.
1) The patient goes into surgery.
2) 13 is watching the surgery and is confronted by Foreman
3) After the surgery and complications, House asks where 13 is, and Foreman says, “Traffic is bad.”
4) Cuddy finds 13 giving herself an IV in an exam room.
5) House fires 13 saying that the surgery was important, etc.
Okay, so: When I first saw it, I thought that the meeting was taking place the next morning, after the operation. This would also explain Foreman’s weird “traffic is bad” line. In which case, 13 would have gone clubbing again, after (or partway through) the operation, showed up [hung over? and] dehydrated, gets caught, and gets fired. But in that case, House’s claim that she wasn’t at the surgery or at the surgery long enough is strange. She definately was there, and the surgery seemed pretty much over. Normally, if you weren’t a character on House, you would expect a routine surgery go finish up in a routine manner. It also figured this meant that 13 left the observation area after getting chewed out by Foreman, and went from there to a club. Sort of panic clubbing, but I believed it.
However, my fiancee pointed out to me, that it seems like it might have all been one night/day, that the clubbing that 13 was recovering from was the one she did the night that she picked up the patient. In that case, the surgery is done and then goes bad, they immediately go to House’s office to debrief him, and 13 goes off to give herself an IV. This causes two other problems: 1) It makes Foreman’s line make absolutely no sense. Traffic is bad where, in the hallway? Is he that bad a liar? Is he aphasic? 2) 13 wouldn’t give herself an IV then. . .she would be expected right back in House’s office, even if the surgery went well. It’s not like she needs a fix, she’s trying to help either her hangover (in which case she should be more hungover or have been more drunk before) or dehydration from MDMA, in which case, a) I think even a spiralling doctor would be able to remember to drink water when Xing, since so many spiralling ravers are able to or b) there’s even more missing time, because there’s no time lag, and she didn’t seem high enough early in the episode.
I suppose she could have done X the day before as well, and could be coming down off of *that* but it still wouldn’t fix House or Foreman’s non-sequitor.
Or am I being way too anal retentive about that point.
October 22nd, 2008 at 3:36 am
I was just reading through the links of the post, and I was reading the entry on Langerhans, and they seem to suggest that while it is similar to cancer, it’s not actually a form of cancer. Doesn’t Foreman refer to it as a “cancer diagnosis” in the show?
October 22nd, 2008 at 6:12 am
Not a DR, but I stayed at a HIE
October 22nd, 2008 at 12:41 am
Why do you doctors have multiple names for the same disease/disorder?
For example gran mal seizure vs. tonic clonic seizure?
Look at wikipedia. There are multiple types of seizures.
October 22nd, 2008 at 6:24 am
Tonic-clonic is the medical term for what was traditionally called a “grand mal” seizure. Calling seizures “grand mal” and “petite mal” is just tradition, much in the way tuberculosis was called “consumption.”
October 22nd, 2008 at 7:52 am
“Nobody? Alright, I’ll be the first to say it:
This was hands down the sexiest episode of House EVER.”
I think a lot of people would agree with that aspect. Hell, I’m a gayboy and thought Spencer was a hottie.. lol.
Hope her and 13 stick it out, but I don’t see it happening.
October 22nd, 2008 at 7:53 am
I spent the majority of this episode rolling my eyes – it turned out to be both the doctor-behaving-badly and suggestive-but-tame-but-intended-to-be-titillating mess I was hoping last week that it wouldn’t be. I will just say that I (and, I believe, most here) enjoy House for the medical mystery and comedy, and to some extent for the character drama, and that stunts like Thirteen making out with random people (two in one episode!) and Cuddy stripping last season seem like puerile attempts to attract the 13-to-17 demographic. My suggestion would be to knock it off until they get some decent medicine going again, lest they become like a certain other show that dare not speak its name *cough*GA*cough*.
A medical ethics question: should Thirteen have been participating in diagnosing/treating Spencer, given their relationship? I’m not a (medical) doctor, but isn’t the emotional investment an issue? This seemed to play a part at the beginning of the episode, when Thirteen kept suggesting that “she’s fine” and wanted to get her out of the hospital ASAP.
I didn’t catch on that Wilson was playing House with the prostitute until the drugs showed up in the trash. The rest of the episode was painful enough that I was worried that Wilson was about to get his own tawdry story arc. What a relief that he’s not. Instead, it looks like Cuddy will next week, which will additionally bring up again the ethics question raised above. (Choose the baby or the mother.)
Regarding the brown recluse spider, I agree that New Jersey is a bit off the beaten path for them. Watching the episode, I missed the brown recluse part, and thought they were saying Spencer had “a spider bite,” which would obviously be easier to miss than a gaping hole of necrotic flesh. (I’ll ignore the lack of symptoms this would cause.) However, brown recluse spiders can move around the country by (unintentionally) hitchhiking on trucks. When I was in high school, I worked at a grocery store, and one night found a brown recluse hiding inside a box of produce. [Edit: after reading about them online, I am now willing to stipulate that it may not have been a brown recluse, though it had the violin pattern on it.] As others have pointed out, this likely was just a ploy to get Thirteen some more skin time with Spencer.
I was hoping that Thirteen would stay fired, and that this would be a step towards returning to the original Young Guns. Oh well. There’s always next week.
October 22nd, 2008 at 7:55 am
I love the crazy syogrens diagnosis with an onion. Whats wrong with a boring phenyl red thread test or a shirmers tear test. surely syogrens can still produce tears, it just highly reduced, otherwise her eyes would be burning and getting blurry vision, due to inadequate eye lubrication. Dry eye is very annoying and patients complain of it brutily.
Also I agree with others, with a diagnosis of syogrens she is dry everywhere, even down there, I guess No 13. forgot about their sexual enconter maybe the extacy impaired her thought processes.
October 22nd, 2008 at 8:36 am
Re. comments on the spider bite examination and the ethics of keeping Thirteen on the case: Some of the soap opera involved House manipulating Thirteen into “connecting” with Spencer–he was diagnosing her ability to care about another human being enough to, well, manipulate her into doing what House wants. (It is not clear to me that it is a loving thing to convince Spencer to have an extremely dangerous and ill-justified bone marrow transplant, but it certainly means that there was some kind of connection.) House keeps Thirteen on the case (and examining Spencer) to keep them close, fires her when it appears that Spencer is terminal, and then he un-fires her because she becomes emotionally involved, which he sees as a good thing. This kind of fits in with his absurd belief that Wilson has returned to normal by rehabilitating a prostitute. As he keeps saying, “If you’re happy, I’m ….”
All of this is soap opera and maybe it explains why the medicine is so very very bad–the diagnoses are designed to manipulate Thirteen into various emotional situations. As soon as a symptom has done that, like the smooth-muscle problem, it can be forgotten.
I am kind of looking forward to the next one. It may be 90% soap opera but at least the medicine will maybe be less confusing.
Judy
October 22nd, 2008 at 8:36 am
“But then Taub’s a plastic surgeon, maybe he forgot how to use a stethoscope.”
LMAO!!!
October 22nd, 2008 at 8:43 am
When Foreman handed Thirteen a paper he found at her apartment, he said that she had taken a test that showed that “You have less time than you thought.” What was the test and what would it say about her Huntington’s?
They should have searched the patient’s apartment too, or at least said they had if they didn’t want the expense of another set.
October 22nd, 2008 at 8:57 am
For crying out loud! She never noticed she’d got xerostomy?! No one ever noticed?! No Doctor? No Dentist?!
What a crappy diagnose!
October 22nd, 2008 at 8:58 am
Diagnosis*
October 22nd, 2008 at 9:02 am
Being a lay-person — the medicine always goes over my head, but even this episode did feel a bit everywhere. However I did find the development of 13’s character to be interesting – i thought the drama involved with a character-who-knows-she-is-going-to-die to be deep
October 22nd, 2008 at 9:14 am
Official Comment
LabbRatt:
When a person has Huntington’s Disease, they have an mutated version of the gene Huntingtin. Normally, this gene ends with a series of cytosine-adenine-
guanosineguanine DNA bases (the “CAG sequence” Foreman mentions) that repeats several times.In people with Huntington’s Disease, this CAG sequence is repeated many more times than normal. Roughly speaking, the more repeats, the worse the Huntington’s. Apparently Thirteen’s gene has a large number of repeated CAG sequences.
October 22nd, 2008 at 9:17 am
I’m beginning to think that Scrubs has better medicine than House.
October 22nd, 2008 at 9:17 am
I stopped the tape of this episode four or five times to yell, in effect, “Brown recluses do not work that way!”
Anybody else find 13’s speech to supposedly-dying patient really, really funny in retrospect, now that we know she’s not dying?
October 22nd, 2008 at 9:32 am
I LOOOOOOVED the House/Wilson interactions… and I totally knew he was pulling House’s leg. Wilson the deviant is my favorite.
But what was with House’s reaction to Cuddy’s adoption!? Wow! That was bad even for him! Jealous much?
October 22nd, 2008 at 9:36 am
Poor House wants Lisa’s babies…
October 22nd, 2008 at 9:39 am
Scott, thank you for the explanation of 13’s CAG sequences. At the end of last season when 13 got the “positive” Huntington’s test, IIRC you said that in real life, the test would tell the number of CAG sequences, not just positive or negative. So in RL, she would have this information and wouldn’t need to take a second test, correct?
When you say “Roughly speaking, the more repeats, the worse the Huntington’s,” does “worse” refer to earlier onset and faster development of symptoms?
October 22nd, 2008 at 9:44 am
Official Comment
Both.
October 22nd, 2008 at 10:01 am
Scott, what’s the House challenge?
October 22nd, 2008 at 10:09 am
EngineeringDr wrote:
My suggestion would be to knock it off (stunts like Thirteen making out with random people and Cuddy stripping last season until they get some decent medicine.
Geeze – you are making engineeres out to be more nerdy than we actually are :) …and I assure you I am not in the 13-17 demographic.
October 22nd, 2008 at 11:15 am
Here’s a little nitpick: when Spencer was in surgery and she began to crash, shouldn’t she have been intubated during the surgery, just in case? If she was already intubated, they wouldn’t have had to waste time doing it, and they could have taken care of her respiratory problems immediately.
October 22nd, 2008 at 11:48 am
That was kind of sad about House & Cuddy. Obviously, what’s happening with 13 is repeated with him- he’s “dying” and in a downward spiral of self-destruction, while the person he “loves” (if he actually has any real concept of the word) has chosen to move forward with her life and “live.” He’s standing on the outside looking in, desperate to be with her.
But in reality I don’t have pity for him. If he worked to make himself more likeable, worked to become someone that other people could admire or even stand to be around and didn’t act like a clown, then he wouldn’t be in that position. It’s all up to him. Bad behavior is not an “illness” that is inescapable- bad behavior and bad character is learned and can be unlearned, it’s as simple as that.
October 22nd, 2008 at 11:57 am
I’m afraid I don’t know much about nonprescription/illegal drugs, but could it have been the ecstasy that Spencer took which caused the grand mal seizure? Thirteen, early in the episode, did note that the ecstasy use would’ve been “too early”, but what is the half-life of ecstasy? Perhaps the writers wanted to write the seizure off to it?
Also, why would you prescribe steroids to treat Sjogren’s? I had thought the first line therapy was a muscarinic agonist?
October 22nd, 2008 at 11:58 am
House is great. Whenever I feel a pity-party coming on, I just have to watch House throw pity-parties and generally make a clown of himself, and I’m instantly inspired to get off my butt and stop feeling sorry for myself!
October 22nd, 2008 at 12:24 pm
Scott – isn’t the G base of DNA guanine? Or is there something about Huntington’s that would cause it to be guanosine?
October 22nd, 2008 at 12:40 pm
Official Comment
Seth:
Another typo on my part. It should read “guanine”
October 22nd, 2008 at 12:52 pm
I fell for Wilson’s stringing House along, because a few seasons ago there was a storyline involving a woman who went south of the border, had unsafe sex, returned home & hired a hooker. When the woman collapsed the hooker had to go with her to the hospital, where Wilson met her and eventually found out she wasn’t really a friend of the woman.
At the end of the episode we saw Wilson calling the hooker, with the implication being that he was doing more than just giving her a medical update on the woman. So…I figured Grieving Wilson might be lonely enough to go that road again with a hooker.
October 22nd, 2008 at 1:26 pm
“Nobody? Alright, I’ll be the first to say it:
This was hands down the sexiest episode of House EVER.”
How have you already forgotten the finale of Season 4 with Cuddy the schoolgirl stripper
October 22nd, 2008 at 1:56 pm
calcifications from renal tubular acidosis cant be removed. I cant believe they presented that as the solution.
October 22nd, 2008 at 1:59 pm
@ Max – Sorry, I guess that I did come off a bit crabby. I wouldn’t say that I’m so nerdy that I’m angry the making out was crowding out the medicine, but it’s not what I’m looking for necessarily when I watch House. I would just prefer that House stick to its strengths rather than move towards a daytime soap.
Now, if you want to see nerd-anger, just get me started on Fringe – ugh! Talk about a hack job….
October 22nd, 2008 at 2:06 pm
Can a single woman (or man) in the USA adopt a kid? Don’t you need to be a (married) couple?
October 22nd, 2008 at 2:29 pm
General doctor question:
Essentially House is a soap opera and about emotions and relationships. BUT in Real Life, don’t medical ethics forbid doctors treating anybody they’re emotionally involved with, love or hate?
October 22nd, 2008 at 2:30 pm
EngineeringDr – All is forgiven. I completely understand your premise. But consider this – If it wasn’t for all of the medical – let say creativeness, there would be no need for Scotts medical review. I must admit that my two favorite times during the week is Tuesday Night when I watch House, and Wednesday morning when I read this blog. (Hows that for Nerdy).
October 22nd, 2008 at 2:31 pm
I’m still waiting for someone, anyone, working with House to haul off and kick him in the nuts. Only Taub seems to have the will to argue with House, and even he just gives in after a token show of resistance. After 13 got fired, she should have told him to get bent. She’s going to die anyway, so why not?
House gets away with too much to be believable. He needs a few more positive traits, otherwise, why would people put up with him. He’s not even such a good doctor, after all…
October 22nd, 2008 at 5:09 pm
The girl stuff was pretty hot, and the rest hard to follow.
I will say that my husband (mid/east NC) has, in fact, been bitten by a brown recluse in the fall, several years ago. He went to the doctor FIVE DAYS later (I nearly killed him over it) and he found out that he isn’t allergic to the spider bite itself, but was still getting necrotic flesh under the skin from the other part of the bite – it didn’t really look that bad from the surface/back of the leg, but the doctor he finally went to cut an orange sized piece out (shudder). He killed several more brown recluses in that time period, same house too, so they aren’t entirely ‘reclusive’.
That said, the bite itself was impossible to miss, we just didn’t know it was a brown recluse bite at the time, since no allergic reaction/surface indication of anything other than a normal, but very nasty, spider bite he woke up with one morning.
Overall, still an enjoyable episode. The kiss was very sweet.
October 22nd, 2008 at 5:19 pm
All I know is that when Cuddy told House that she had gotten the adoption approved, House’s face of extreme shock mixed with disappointment and whatever else made me burst into tears.
I don’t much care about the medical part anymore, just care to see where it will lead the plot.
October 22nd, 2008 at 6:10 pm
Hi, I just wanted to say huge thanks to you for your reviews. You’re awesome at it.
I find them extremely useful since a group of friends and I are making the Russian version of subtitles for House episodes. We do have a doctor helping, but the rest of us know very little about medical stuff. Your posts help a lot.
So, once again – thanks a lot from Russia. Keep up great work!
October 22nd, 2008 at 6:40 pm
I liked it. No one mentioned foreman that much. How is he boring? Remember when he was dying and intentionally infected Cameron to save himself? Not boring at all. I think foreman is falling for 13. He never cared about anyone but himself before. How bout that eh?
October 22nd, 2008 at 6:41 pm
By the way: If your happy I’m…..
October 22nd, 2008 at 7:38 pm
Last I heard (about 20 years ago), patients with LAM all underwent hysterectomies. Wouldn’t this or another treatment at least have been discussed? Do they now use tamoxifen or some other drug to prolong the lives of these patients? Thanks.
October 22nd, 2008 at 9:11 pm
The inhaler appeared to be just an over the counter Primatene… no spacer included nor any mention of a spacer in the directions on the package.
October 22nd, 2008 at 9:44 pm
“I’m afraid I don’t know much about nonprescription/illegal drugs, but could it have been the ecstasy that Spencer took which caused the grand mal seizure? Thirteen, early in the episode, did note that the ecstasy use would’ve been ‘too early’, but what is the half-life of ecstasy? Perhaps the writers wanted to write the seizure off to it?”
It would be very unlikely for Ecstasty (MDMA) to cause the seizure. The big dangers with MDMA are dehydration and overheating, but there is also the chance of Serotonin Syndrome (also called “serotonin storm”) which could cause a seizure – but that would usually occur a short time after the overdose or reaction, hence 13’s “too early” comment.
October 22nd, 2008 at 10:04 pm
Official Comment
Keith:
Primatene would not cause a candidal infection (nor would Albuterol, the most common — and most appropriate — inhaler for occasional use). That requires a steroid inhaler.
October 23rd, 2008 at 12:08 am
Did anybody else catch that reference to Eliot Spitzer when House told Lukas to find Wilson’s girlfriend’s “client #9″? I thought that was pretty funny.
October 23rd, 2008 at 12:10 am
I recall seeing an episode of ‘Medical Mysteries’ on The Learning Channel about this disease. This woman suffered from it for something like 20 years before getting a diagnosis, and it was an eye doctor who made it.
What I find amazing every week is how patients with these chronic conditions struggle along until they get to see the great Dr. House, then once they’re in PPTH their conditions suddenly become life-threatening. With no explanation except that proximity to House makes people sicker.
I really enjoy your posts Scott, I find I need them to understand what’s going on.
October 23rd, 2008 at 12:52 am
Dr Engineer, you hit on just the thing! Watch ‘Fringe’ just before ‘House.’ It’s like a desensitizing cerebral anesthetic.
My question for the good Doctor Scott is about a fundamental premise: I know the situation is fictional, but are Thirteen and her cohorts actually learning anything? I can’t imagine why she would /want/ that job, otherwise.
My background is legal, not medical, but the way House treats employees would lead me to believe Dr Cuddy should be more worried about Thirteen bringing a job action against the hospital than any drug habit. (That she’s familiar with.) Would you put up with that sort of treatment?
October 23rd, 2008 at 2:49 am
This was a great opportunity to get rid of 13. :-(
October 23rd, 2008 at 7:17 am
I have only recently dicovered your website and I must say it’s incredibly interesting. I’m a fourth year med student, so when the medicine on House is down right wrong I usually don’t buy it. But a lot of the more trivial stuff just goes over my head. Except when I read your review! It’s great, thank you!
And the girl-on-girl action might have been a ratings stunt, but for a lesbian med student like me it’s good to see some representation of non straight female doctors on television (without them being basically asexual).
October 23rd, 2008 at 10:31 am
“…I might stop watching House soon, since [they're]… forgetting their audience is actually intelligent.”
“I guess **there** medical consultants are drunk or something…”
Hm.
October 23rd, 2008 at 1:11 pm
When taken in clubs in this area, MDMA is usually called that by name, comes in capsule form, and is (relatively) pure. Ecstacy or E (they call it X in the US?) is much cheaper; coming in a pill form containing filler, dye, and who knows what else! (You pays your money and you takes your chances.) Whenever ‘ecstasy’ is suspected as the cause of a medical emergency; the first thing the authorities will do is try to get another pill from the same source/batch and have it analysed to find out what was _really_ in it before jumping to any list of pat diagnoses.
October 23rd, 2008 at 1:38 pm
Though there are concerns about the medical details, and the liberties writers may have taken in this episode of HOUSE, the fact that millions of people have now at least heard of some of these diseases is a service to those who are diagnosed with them.
Every day, at least 30 people in the U.S. are diagnosed with aplastic anemia, myelodysplastic syndromes (MDS) or paroxysmal nocturnal hemoglobinuria (PNH).
Learn more about bone marrow failure diseases at http://www.AAMDS.org.
The Aplastic Anemia & MDS International Foundation provides free educational information and a host of patient and family support services to those families facing the life-threatening bone marrow failure diseases of aplastic anemia, MDS and PNH, among others.
Your interest and your philanthropic support are welcome. Thanks.
Sandra Walter
Director of Development
Aplastic Anemia & MDS International Foundation
October 23rd, 2008 at 2:26 pm
Every week it just gets worse. Why House, Why??
I keep thinking its gotten as worse as it can get and well they just prove me wrong.
As a young medical student, House is just confusing the crap out of me. Who are these medical consultants and where did they come from?
Does it bother anyone else that 13 is too young to be in a position on House’s team? And what happened to her nasty yeast infection of the mouth at the end when she’s making out with random girl #2??
Its so frustrating!!! I really hate 13!!!
October 23rd, 2008 at 2:26 pm
@ Max – yes, I believe that racing here on Wednesday morning is indeed a hallmark of nerdiness. :^) Let us be thankful that nobody here posts in L337.
@ corvus imbrifer – I’m afraid I disagree… ‘Fringe’ is less of a neural anesthetic than a potent hypertension-inducer. Every few minutes I start yelling (at least in my own head) “That wouldn’t happen! This is so stupid!!!” and so on. I believe this week’s episode involved something like radioactive particles injected into someone’s bloodstream that simultaneously “emitted radiation” via some remote control, blowing up the person’s head. Luckily the channel was changed before I hurt myself hurling abuse at the TV. I imagine Scott acts similarly to House, though all we see of it is the list of angry red caducei after the review.
October 23rd, 2008 at 7:25 pm
Do real doctors do a differential diagnosis sitting in a group around a whiteboard without consulting any reference material? I would think it might help to look up things in a book, journal, library, or website (or contact a specialist).
October 23rd, 2008 at 9:51 pm
Only slightly related now…
I’m curious- is ecstacy the same stuff they warned me of as a little kid with the “if someone comes to the school & offers you little tabs with a blue star on them *dont take them* they’ll kill you” schtick? [or maybe it was a red star or a smily face, or something. Do they still warn kids about that or did I just have overly paranoid teachers?]
if not what was in the blue star tabbythings. I’ve always wondered.
October 24th, 2008 at 1:34 am
I loved the House/Wilson scenes. Basically that’s all I watch for now. The medicine just doesn’t make sense. And House seems to be distracted and off his game. The same sex love was hot. I just hope we can give equal time to my favorite boys.
And I loved the very subtle thing the writers did with House’s reaction to Wilson’s fake hooker and Cuddy’s baby mama drama.
It looks like we’ll be getting Fetal Position II next week. And for the poster who said House was in love with Cuddy must be watching a totally different show. The only person its clear House is in love with – is Wilson.
OW is an excellent actress. Taub need to practice the medical words so he can deliver them like a REAL doctor. A couple of times it seemed like he was out of character.
October 24th, 2008 at 2:23 am
Blue star tabs would most likely be acid Sable
October 24th, 2008 at 7:21 am
the mastocytosis diagnosis was completely out of the blue and completely inaccurate in terms of it possibly killing the patient within days. I mean, yes theoretically shock or vascular collapse could kill her at any given moment, but there are lots of us out here living with masto.
October 24th, 2008 at 9:40 am
The seizure at the beginning of the show could have been caused by hyponatremia, or low sodium in the blood. I understand this can happen with Sjorgen’s due to increased water/fluid intake from dryness, which causes imbalances in blood sodium levels, which can lead to seizures.
As for the girl on girl action – fairly tame in my opinion. I do agree that Wilson’s twist was fun to watch, and House’s reaction at Cuddy’s news at the end was very sad.
October 24th, 2008 at 10:11 am
Sorry to tell y’all – but just because you have Sjogrens doesn’t mean that you are definitely dry “down there”. I know – because i have Sjogrens and am not.
October 24th, 2008 at 10:14 am
the initial seizure might have been from the Sjogren’s as well as the fact that she was dehydrated from the partying and drugs! I agree that sometimes the House medicine can be a tad sloppy…but maybe we are just too keen to find mistakes sometimes! :-)
October 24th, 2008 at 11:37 am
Why would you think it is acid? It won’t kill you and it’s even harder to make than MDMA anyway…
October 24th, 2008 at 3:47 pm
In reverse order:
@PX – For those of those who grew up in the 80’s “Blue Star” is automatically mapped to “blue star tattoos“, a supposed scheme where drug dealers distributed temporary tattoos to kids that were infused with LSD, “hooking them” with this sneaky free sample. Ignoring the obvious point that LSD is not addictive, there was a great scare in schools resulting in temporary tattoos being banned in many schools. The name ostensibly came from the original temporary tattoos being of blue stars, but later ones were ostensibly emblazoned with cartoon characters to better snare the tots. It’s all rubbish, of course.
@willem kompaan – It depends on where you are. The basic foundation of most adoption law is ensuring that a child is placed in a stable family environment. For this reason, single parent and same-sex couple adoptions face additional hurdles in proving their suitability (even outside of the bias towards the “atomic family” of two opposite-sex parents, there can be legal issues if a parent dies. In a same-sex couple, often only one parent actually has custody, although this may be changing with gay marriages (or “civil unions”) becoming legal. And, of course, for a single parent, if one parent dies, the child is orphaned once more). This isn’t even getting into the fact that some agencies still insist on a child only being paired up with parents of the same race/culture/physical disability (some agencies will only allow deaf couples to adopt deaf kids). But it is indeed possible for a single parent to adopt.
Regarding recluse bites in general, my impression is that they’re over-reported and the effects of their bites are over-hyped by nervous doctors. Indeed, I’ve never met anyone with actual scarring or damage from a recluse bite, but I’ve known some people where the doctor found out they got bitten and automatically scooped out huge gobs of flesh, leaving the scarring and damage. Some cases of which, they never did know if they actually got bitten by a brown recluse.
October 24th, 2008 at 9:15 pm
It really bothered me how they had thirteen doing a full body exam with no nursing assistant present, not even another colleague, I mean that is a lawsuit just WAITING to happen. So annoying…
October 24th, 2008 at 9:44 pm
I remember getting an email with pictures of a guy who’d been bitten by a brown recluse… his hand rotted off in the end. Isn’t it great how of the only two spider species to cause necrosis, Americans get the “reclusive”, and my wonderful Australia gets the white tailed that’s basically a bigger badder version of the red back? i love Australia, so full of poisonous creatures!
Whats xerostomy?
Is it legal for dr’s to give themselves IV fluids the way 13 did?
When the hell did we find out that the girls name was spencer? and what kind of a girls name is spencer anyway?
and hey, maybe 13 is just *that* good that there wasnt any dryness in any “significant” areas. :P
October 24th, 2008 at 10:18 pm
Official Comment
xerostomy = dry mouth
It’s perfectly legal to give oneself IV fluids. It’s starting your own IV that can be tricky…
At the very end of the episode, Foreman came up to Thirteen and said something like, “Aren’t you glad that Spencer’s better?” That’s the first — and only time — the name was mentioned.
October 24th, 2008 at 11:27 pm
Well, I can’t say the medicine was great, but the spider bite hunt and the bone marrow transplant form strike me as House messing with 13 more than as legitimate mistakes. Maybe he just wanted to see if she could get Spencer (?) to sign the damn thing or if 13 was dumb enough not to notice that it was an idiotic thing to have her signing in the first place. For the spider bite, I’m 100% certain we’re not supposed to take that seriously. House just wanted to make her paw at a hot girl for a while.
October 25th, 2008 at 3:37 am
Book on abortion.
A few minutes into the episode, when 13 is talking to the rest of the team about what happened (she says something like “abuse of alcohol and e….problem solved”), Foreman is standing next to a bookshelf. The first time he’s in camera, there’s a book on the shelf next to him labeled “abortion”. When the camera returns to him seconds later, the book is gone.
I notice these random things.. :-)
Great blog, man!
October 25th, 2008 at 7:16 am
I keep on being disappointed with this whole season. I liked this and the previous episode a little bit more cause Wilson is back, but that´s all. I´m not sure about next week´s ep, is it going to involve personal emotions again???
1. I can´t imagine anyone kissing a patient with untreated Sjogren´s and not noticing his/her dry mouth and bad breath.
2. The inhaler Thirteen had looked like a bronchodilater one, not a steroid inhaler (even that there are steroid inhalers of this type on the market). But I guess she´d get a beta-sympathomimetic inhaler to relief her problems. Spacer isn´t a standard supply for adults, but it is surely helpful.
3. Sjogren´s syndrome is an autoimmune, so steroids are OK at least at the beginnig of the treatment.
4. Some doctors give themselves IV when not feeling well (hangover, fatigue or even cold or flu). It´s surprising how well it works!
October 25th, 2008 at 7:37 am
For all fans: this is a really great “House MD for Children” book by russian fan of the series. All texts are in russian, but all the characters are recognizable.
http://savil-mik.livejournal.com/34616.html
October 25th, 2008 at 3:59 pm
Another life saved by girl on girl action.
October 26th, 2008 at 2:54 am
Somebody asked before: “What explains the seizure that started the whole episode?”. Sjögren’s syndrome caused the seizures (and can also cause a sundry of other CNS manifestations). Link: http://ard.bmj.com/cgi/reprint/63/6/616.
October 26th, 2008 at 3:30 pm
RTA wouldn’t lead to HYPERkalemia instead of HYPOkalemia? I assume she would be acidotic due to RTA… Am I wrong?
October 27th, 2008 at 2:01 am
[...] Tutto sommato, un altro ottimo episodio. Dal punto di vista medico l’analisi è impietosa, ma in questi ultimi tempi la verosimiglianza è spesso carente. Tutto il resto, però, compensa ampiamente. Direi quattro stelline tonde tonde. [...]
October 27th, 2008 at 11:08 am
To Jean – yes she would be acidotic, and RTA can be managed it is not curable.
October 27th, 2008 at 4:12 pm
Thanks again for an excellent review, Scott!
To be honest, I’ve got a soft spot for Thirteen… this episode was a bit dramatic here-and-there, but she sure’s hot, and so were her girl-on-girl scenes.
I still think the series suffers from a “too many protagonists” problem – they have to make things up to have a bit of screen time for Chase and Cameron.
October 28th, 2008 at 2:05 am
Well, the 13 Spiral is coming straight down the page… We knew that she was going to star in a “girls gone wild” episode, and here it is…
It’s looking like there will be a Foreman falls in love with her and watches her die arc, too.
Here’s hoping that when it happens we don’t have four episodes of him blaming it on House, like Wilson did when his girlfriend died (and I still can’t quite buy the Wilson/Amber Love Story, to be honest…)
I wish she would have stayed fired. I really don’t like any of the new doctors, but her chracters seems the most forced… like they just added her for the “cool plot twists” they could inject.
I have to say that the Wilson/hooker thing got me. It did sort of seem like something he would do. I loved the out-foxing the PI story line… that was good stuff.
This episode was disappointing on many levels though. Last week’s episode, with the Wilson/House road trip was by far and away the best of the season. The writers ought to look at that and realize what makes the show work… then look at this episode… and realize what doesn’t…
October 28th, 2008 at 11:21 am
While the bone marrow transplant without a diagnosis was completely unwarranted and probably the hospital wouldn’t consent to being used for it, doing a transplant without total-body irradiation isn’t exactly a new concept. Non-myeloablative allogenic transplants, or “mini-allo”, have beein practiced for a while now, mostly in elderly or otherwise incapacitated patients with CLL or indolent lymphoma who wouldn’t be able to tolerate myeloablation.
October 28th, 2008 at 10:09 pm
I have a much better idea and I think Im way better that House check this out:
1. Starts with tonic-colonic seizure due to a brain hamarthoma
2. progresses with kidney problem due to a autosomal dominant polycystic kidney with calcium deposits
3. LAM with cyst in the lungs
2 major and 1 minor criteria for Tuberous sclerosis complex
I had to check the channel to make sure it was Fox…showing hot lesbian action..the ultra right religions evangelical wing..my my whats going on with the world today….
October 30th, 2008 at 4:03 pm
Can 13 get a consent when she is fired? Would that be legal? Technically shes just a visitor, or?
October 31st, 2008 at 5:15 am
For one moment I nearly hoped that 13 could get fired too.
But I don’t think that’s ever gonna happen in a long term view. Because the poor girl is gonna controled and experimented by House until she die.
Also, I don’t think House was deflecting with 13 when she asked him what’s changed when she was re-hired. I think House was simplely in a better mood thank to Wilson.
November 2nd, 2008 at 12:51 pm
While the doctors who feed David Shore with ideas seem to be sleep at the wheel sometimes, the complete opposite should be said about the people working on the music of the show.
In addition to the connection b/w lyrics and the last part of the show, Annie Lennox’s “Dark Road” starts with Thirteen sitting at the edge of her bed, just like Lennox in her video clip. On the dot, very well done.
This is only one example, but there are many. Anybody know who picks the music in House?
November 5th, 2008 at 1:26 am
Thirteen’s chopped lips led House to speculate that the patient has that saliva-production-suppressing disease! House thought it may be due to the lack of lubrication when Thirteen and the Patient kissed!
November 5th, 2008 at 10:07 am
Going on from what Erin and IMH were discussing about the seizure, MDMA/ecstasy can cause hyponatraemia due to its effect on ADH secretion. I’ve heard of cases where this mechanism has lead to seizures.
November 11th, 2008 at 12:16 pm
Loved your review of this episode of House. A few things to add.
1. With cystic disease such as LAM, you would never cut out the cysts. also unlikely that surgeons would cut out renal calcifications.
Tension pneumothorax–would require chest tube insertion and may take a long time for the lung to reinflate.
2. LAM is often associated with kidney tumours (also tuberous sclerosis); so that might explain the kidney problems at the beginning of the show
3. Usually you cannot diagnose cystic lung disease with an x-ray only.
4. The House docs didn’t check for other cystic lung diseases such as alpha-one-anti trypsin.
5. Spenser seemed to miraculously recover from a. kidney surgery, b. pneumothorax, c. lung biopsy, d. having her lung cysts removed etc etc.
6. LAM often coexists with asthma, so it would be okay for Spenser to have a bronchodilator inhaler.
7. Why are there no nurses or other hospital personnel; Spenser doesn’t seem to have a family/friends… where are all the other people?
etc etc
November 12th, 2008 at 6:46 am
Does anyone know either the name of the song that comes on towards the very end: starting with Cuddy, Wilson and House in the baby boutique, and continuing into when 13 is hooking up with a new girl? The lyrics are something like “it’s a dark room and a dark way that leads to my house
in the words say and you’re never going to find me there, I’ve got an open door it didn’t get there by itself, it didn’t get there by itself
there’s a feeling that you’re not feeling it at all, there’s a meaning but you’re not listening anymore
it’s a meaning” I’ve tried doing lyric searches but to no avail. Thanks!
November 14th, 2008 at 9:39 pm
The song at the end is “Dark Road” by Annie Lennox
December 6th, 2008 at 7:24 am
Very nice review. I am a medical student and i love House series, but sometimes i am also wondering about their medical facts. I enjoyed reading your review. Now i have a new site to look into after i watch every House episode. :)
December 7th, 2008 at 12:03 pm
whats the song in the first of the episode
December 28th, 2008 at 6:16 am
Here’s a website that specifies the music used in each episode of “House”:
http://www.have-dog.com/house/
The song title you “need to know,” Kayla, is “Cheap and Cheerful” by “The Kills.”
January 3rd, 2009 at 11:59 am
Hello,
There’s another typo
Paragraph 4, line 8: streptococcal
January 16th, 2009 at 4:20 am
13 suspected that the seizure was a fake. Spencer may have said it wasn’t, but she obviously has a history of deception. Lies could easily account for that symptom, and so I think the fact that the diagnosis doesn’t explain it should be such a big deal.
March 9th, 2009 at 2:55 pm
This episode is a good demonstration of how extremely conservative the show actually is, despite the facade.
Casual sex – can’t be good wholesome fulfillment of sexual desire – nay, it’s part of a ’spiral of self-destruction’, and indicative of emotional blunting. Same for drug use (the dangers of which are always ridiculously exaggerated). Also, atheists are miserable and at best amoral (otherwise downright immoral).
Bah.
April 5th, 2009 at 9:21 am
wow she has xerostomy and does x regularly apparently,
the show’s writers really missed big on that one
xerostomy would make using x pretty much a waste since taken properly it is dissolved in your saliva, although it can be swallowed the potency is reduced in doing so
also if someone taking it is experiencing dry mouth or any other sign of dehydration they wouldnt take the drug since dehydration is exacerbated on x and it also increases the neurotoxicity of the drug.
no heavy user of x would take it with xerostomy it doesnt make any sense especially since it isnt physically addictive
finally the seizure can easily be explained by the x if she took it 5 hours before and just had sex. the stimulant effect of ecstasy lasts 4-6 hours on average. and any cardiovascular activity during that time could put strain on the heart enough to induce a tonic-clonic seizure so it couldn’t be so easily dismissed as a non cause
April 22nd, 2009 at 1:30 pm
If i remember correctly, i believe she admitted to faking the seizure in order to get the attention of House’s team. Tonic-clonic seizures are the most common faked (see the episode “here kitty”) because it is the type of seizure most people think of when they think of seizure (stiffing of the muscles, dramatic muscle movement, etc.) Whereas no one ever tries to fake an absent seizure or a partial seizure.
May 9th, 2009 at 10:28 am
The patient fakes the seizure. She admits that later in the episode.
Is it just me, or the show is just getting boring, filler and less humour?
May 31st, 2009 at 3:40 am
yeah i forgot about it
but the ecstasy comment still stands. i mean even though she adimitted it later doctors should rule out a seizure because the drug was taken hours beforehand like it was in the diff that was my problem. it was ruled out way too quickly. the amphetamine effects + sex on ecstasy can cause a seizure easily.
my comment on the neurotoxicity of ecstasy combined with xerostomy still stands though
June 25th, 2009 at 10:45 pm
Fist-pounds all around for the lesbo scenes.
January 21st, 2010 at 2:56 am
About what Daniel said, well, almost a year ago: I don’t think the show was making a point that it hurts to have casual sex, what they called a downward spiral was the getting drunk and taking drugs and partying every other night and going to work the day after, plus having sex with people whose name she doesn’t even know and whose motives she could easily miss, as she did with this girl (and she *was* hurt that Spencer was using her); and she herself has the wrong motives, if House is right about her control issues.
As for the drugs and exaggerated dangers, my impression is the opposite — often when the patient is proven to be using or have taken drugs, it’s not the cause of the problem.
About atheism, misery and morality — just about everyone on the show is miserable in their own way, regardless of their life philosophy, even nuns and priests (which is understandable, as happiness does not make for great drama), and very rarely is a moral decision connected to religious beliefs or lack thereof.
An episode lasts about 42 minutes, so the handling of all controversial issues is bound to be somewhat simplified.
May 8th, 2010 at 2:07 pm
first off i love House and Love your site! i have wondered if any doctors really enjoy the show or not. my uncle was a doctor before he made alot in some investments and retired. he reminds me a ton of House as he is nearly void of any care for humanity… he just wants to prove he is right lol. i really want to contact him someday and watch his face as he watches House. i like the reviews that you do but apreciate them all the more with the red, blue and green points at the end. i like to know what exactly is wrong or off about the show. and its nice to hear your personal perspective of it. i did want to say … regarding the seizure at the beginning… im pretty sure i remember the patient finaly addmitting to faking it. maybe i am wrong… but that is what i remember. she said something to the effect of “ok, so maybe i did use you to get to House” (a really cheesy line however) then it seems like she addmitted to taking something to induce the seizure, or faking it… i will have to watch it again to be sure… but it does explain it as something the patient did if i remember right. im like 95% sure. either way… thank you again for your site. its very entertaining and enjoyable to read.
June 7th, 2010 at 7:53 pm
A major complaint was that the seizure was unexplained, but it seemed quite clear to me. Sjogren’s syndrome caused renal tubular acidosis, type I (RTA 1) which caused hypokalemia. Hypokalemia caused the seizure.
The real mystery is why it took so long that the patient was hypokalemic considering potassium is part of the basic chemistries that get checked almost immediately. Moreover, you can’t treat RTA 1 just by surgically removing calcifications on the kidneys. They’re a sign of disease, not the cause. So basically, they operated on her for no reason and conveniently forgot to consider the differential on what causes RTA 1.
September 14th, 2010 at 5:22 am
Thirteen having a rubout with a pretty girl made me forget all about looking for misdiagnosis or other missing links.
November 19th, 2010 at 12:25 am
Actually, Spencer fakes the seizure to get to House. It is explained in the episode.