House — Episode 10 (Season 5): “Let Them Eat Cake”
An enjoyable episode of House; one of the better of the season. A good mystery, and the medicine was generally decent. Some nice battle of wits soap opera as well.
Emmy, a thirty year-old fitness instruction, is filming an infomercial when she experiences sudden difficulty breathing and collapses, breaking her ankle in the fall. She is admitted to House’s service for evaluation and all the initial tests were normal. Taub suspects her of steroid use, Kutner mentions environmental allergies, and Cuddy suspects exercise induced asthma. The last seems the most likely, so the team sets about to recreate Emmy’s episode, the best they can with her broken ankle. Sure enough, while in the middle of exercising, she once again collapses and is found to be pulseless.
Kutner suggests she may have Carcinoid syndrome. A CT is obtained which shows no carcinoid tumor, but does reveal that she has had gastric bypass surgery in the past. This catches the team by surprise, and has them rethinking their differential diagnosis: now diabetic neuropathy (nerve damage caused by diabetes) and sleep apnea are added. Thirteen suggests gastrointestinal malabsorption leading to a low potassium, but Kutner takes it one step further and thinks Emmy may have SIBO (small intestine bacterial overgrowth) in a blind loop of bowel, and that these bacteria are making their way into her blood stream causing her symptoms. They test her stool, but there is no evidence for bacterial overgrowth or fat malabsorption.
House decides to rethink sleep apnea, and has Kutner and Taub run a sleep study. During the test she sneaks out, and the pair find her exercising on a treadmill, her ankle still in a splint. They also notice she is bleeding from the ankle and never noticed — she has lost sensation in her foot. The differential now includes multiple sclerosis, Parkinson’s Disease, and transverse myelitis (a crosswise inflammation of the spinal cord). House orders a nerve conduction velocity test (NCV), but while setting it up, Taub realizes that she is losing muscle strength in her arms. This again changes the differential, and the team considers myasthenia gravis, botulinum toxin exposure, other toxins, or heavy metal poisoning. House has them start her on chelation to treat her suspected heavy metal toxicity, but there is no change in her condition. The latest differential consists of a corornary-cardiac fistula (an abnormal connection between the coronary arteries — which supply blood to the heart muscle — and the interior of the heart), Austrian syndrome (meningitis, pneumonia and endocarditis caused by the Pneumococcus bacteria), or Guillain-Barre Syndrome (an autoimmune disease of the peripheral nervous system). The latter fits the symptoms the best, so she is started on the treatment for Guillain-Barre, plasmaphersis.
When Emmy starts hallucinating, the team realizes that the Guillain-Barre diagnosis is wrong as well. Thirteen favors a diagnosis of CNS lymphoma, but Taub is suspicious she has a prion disease (a rare type of disease caused by infectious protein particles. The best known example is probably mad cow disease). House wants a brain biopsy, but Cuddy won’t let him until they’ve ruled out other brain tumors by non-invasive means. The initial tests come back negative and House decides to perform the brain biopsy himself. However, when he and Taub enters the room, they find Emmy up and about, feeling good. Taub informs House that there have not been any new drugs, but that she did eat a piece of chocolate cake from the cafeteria. House now realizes the cause of her condition — she has hereditary coproporphyria. This is an inherited disease that House tells her can be controlled by a high carbohydrate diet. When she was fat, she ate that type of food all the time, so suffered no ill effects, but now that she is slender and eating healthy, the symptoms have caught up with her. He recommends resuming the high carbohydrate diet, but she chooses to continue her low calorie diet and take medication to control her symptoms.
Major complaints are in red, minor in blue, nit-picking in green. Overall, not too many big errors this week, but many of the diagnoses were quite a stretch.
You don’t test for SIBO with a stool study. You need an aspiration of fluid from the small intestine to evaluate or a hydrogen breath test. Plus, if she has a blind loop of bowel, how are the bacteria from it going to end up in the stool to be tested?
She was pulseless, but they never specifically said what her rhythm was. If it was asystole or PEA, then defibrillation was wrong. Otherwise, it was probably right. (And I’m still not too clear on why she coded in the first place).
The time course was off again, but in different way than usual. Emmy must have been several years out from her surgery — she had the weight to lose, the muscles to tone, the fitness guru-ness to obtain, and the informercials to produce and distribute — and only now does she start to have symptoms?
And she never had symptoms with a low carb diet while trying to lose weight before her surgery.
Diet alone is not the best treatment for severe CHP attacks. A drug known as Hemitin also helps.
A high carbohydrate diet is recommended by some physicians. Most doctors recommend a healthy balanced diet with high carbs only during acutre attacks.
Abdominal pain is a key symptom of coproporphyria.
Several episodes this season where diagnoses are made by looking at the urine color and they miss the classic purple urine in this one?
The medical mystery was good this week and deserves an A. The final solution was fairly clever, though a bit of a stretch, and earns a B. The medicine, though again quite a stretch at points, was good overall and also earns a B. The soap opera was well done, both in terms of House/Cuddy and Thirteen. I give it an A, with extra credit for Cuddy’s comment about House’s balls.
December 2nd, 2008 at 10:00 pm
Cuddy’s comment about House’s balls had to be one of the best remarks of the season. I also loved all of the Wilson scenes, as usual, though (as usual) there weren’t enough of them. Learning more about Thirteen was a nice bonus, though I was a bit disappointed that the writers didn’t take the opportunity to delve a bit more into Taub’s story–he is still the least 3-dimensional of the new team, at least in my eyes. Overall, though, really great, enjoyable episode, one of the best if not the best of the 5th season so far.
December 2nd, 2008 at 10:10 pm
Guillain-Barre never really made sense, at least the way the team explained it (as induced by the surgery). Guillain-Barre syndrome would onset within several weeks of the surgery, not years afterwards.
Scott, I think you’re getting paranoid about improperly shocking flatlines! Emmy was not defibrillated, at least not on camera. The only thing shown on camera was Taub’s awful technique with the bag-valve-mask (performed while Emmy was lying on her side; might want to roll her to a supine position and open that airway first).
December 2nd, 2008 at 10:11 pm
Wow, I am very impressed by how fast you get these reviews up. Keep up the good work! I really enjoy reading them.
I also want to point out that it was Lori Petty as the Huntington’s patient in the waiting room that Thirteen was watching, and she’ll be back next week too. She’s a fine actress and I always like seeing her get work. Hooray!
December 2nd, 2008 at 10:14 pm
My compliments to whoever prepared the preview for this episode – they made it seem more promising than it turned out. (In other words, I was kind of let down.)
The scene where the fitness guru’s followers ganged up on her was so obvious, the director might as well have flashed the word “HALLUCINATION” (or, in this case, “NIGHTMARE”) on the screen.
And have I become such a fuddy-duddy that, not only do I use terms like “fuddy-duddy,” but I’ve started to find Cuddy’s low-cut outfits offensive (not to mention unbelievable)?
But any malady that can be treated with copious amounts of chocolate cake is all right in my book.
December 2nd, 2008 at 10:18 pm
An okay episode of House this week!
December 2nd, 2008 at 10:28 pm
It was not on camera, but they did mention that they shocked her.
I guess that Foreman’s trial is not an RCT, otherwise it would be a 50-50 shot of 13 getting a placebo. I’m guessing it’s a case series phase II trial. A phase III trial would have to be randomized and double blinded, but it sounds like a phase III trial from the way Foreman describes it, and there no way it’s a phase IV trial, and phase I seems unlikely as well..
Scott, did you know your reviews are linked to from the House episode pages on Wikipedia?!
December 2nd, 2008 at 10:30 pm
House said the patient had a defect in an enzyme with a name he couldn’t pronounce. The enzyme is coproporphyrinogen oxidase. I can’t pronounce it, either.
The two scenes at the end with the hooker were great.
December 2nd, 2008 at 10:38 pm
I have to add that I loved the side story with Kutner using Houses name and the patient coming into the hospital. It’s reminiscent of previous seasons with the kooky clinic patients.
I also love how Wilson is trying to hard to get House and Cuddy together.
December 2nd, 2008 at 11:03 pm
Official Comment
Matt C,
I may be paranoid, but with good reason. When Taub was explaining what had happened to House, he said that they “shocked” her back into a sinus rhythm. So while they didn’t show it, they mentioned it.
December 2nd, 2008 at 11:11 pm
Aacckkk—Tivo disaster!
Can someone please tell me what happens in the last minute, after House says “I booked our little thespian here for two full days. That’s 3 g’s I owe her.”
Thanks!
December 2nd, 2008 at 11:21 pm
steevo619:
The young woman tells House, “You still have three hours left.” “Do I?” says House.
Cuddy, still warm and fuzzy over the desk, walks toward House’s office, only to spot him hobnobbing (or whatever you’d call it) with the young woman. With a look of disappointment, Cuddy turns around and walks off. End of episode.
December 2nd, 2008 at 11:37 pm
Official Comment
Karl,
I’m thinking it’s a Phase III trial, since according to Foreman, they already know the drug “shows promise.”
I had noticed the links from Wikipedia. I’m very flattered (but for the record, my favorite Wikipedia links are the ones from the articles on Gunners and Hawk and Dove.)
December 2nd, 2008 at 11:42 pm
I was glad to see them finally deal with Huntingtons properly on tonight’s episode. After a positive test result with no mention of the repeat count and then talk about the count as if it was some sort of follow up, it was nice to see them get it exactly right for a change. Thirteen’s story was quite similar to anecdotes I heard both in my late wife’s family and caregivers support group; and the depiction of the physical symptoms (although it doesn’t present this way in everyone) were eerily accurate. Even the description of her mother’s brain ’shrinking’, while a simplification, was accurate enough for a sound bite on a tv drama. As someone affected by this disease I was both sad and happy to see it so well done — hopefully some of the many who watch and respect this show are affected enough to start asking questions and getting involved. Hopefully.
December 2nd, 2008 at 11:43 pm
I read a quote from one of the directors saying that Cuddy and House’s relationship will “not be linear.” No joke.
Anyway, my favorite part of House is the quips and the quick back and forth between House/Wilson or House/Cuddy. I’m so glad to see that making a return. I love the humor in House.
If you can diagnose this condition just by looking at the purple urine color, I’d say that’s more than a nit pick. That sounds like a three minute episode. Speaking of which I’ve always wanted them to write an episode where the case is solved midway through just to throw us off. Because they say it’s solved halfway through but we know…. There’s still 25 more minutes left!
December 2nd, 2008 at 11:46 pm
HOUSE: What also floats in water?
ME: A duck!
TAUB/KUTNER: *blink blink*
HOUSE: ….The correct answer is A DUCK.
ME: YAAAY!
There are Monty Python geeks in the writer’s room!
December 3rd, 2008 at 12:00 am
Medical Experts: Could thyrotoxic periodic paralysis have been considered in the differential? Why or why not?
Great review! Keep’em coming!
December 3rd, 2008 at 12:06 am
I didn’t get the disappointment in cuddy when house grabbed her boob. He and I both agree, it is the next logical step. I don’t understand why she took offense. She should have taking it as a compliment coming from house. Any one care to explain this to me?
December 3rd, 2008 at 12:17 am
Stools that contain only fat (steatorrhea) do NOT float. That’s a really old medical myth that was debunked almost 40 years ago: http://www.ncbi.nlm.nih.gov/pubmed/5015442?ordinalpos=68&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum.
Only gas trapped in stool can make it float, although a stool containing excess fat from generalized malabsorption may be more likely to contain more gas due to fermentation of malabsorbed carbohydrates.
December 3rd, 2008 at 1:15 am
This is the first episode this season that reminded me why I like this show. The Monty Python reference, battle of wits, trickery, and *decent medicine*. Bravo.
I still miss clinic and think there are too many characters right now, but overall, well done.
December 3rd, 2008 at 1:56 am
You said under one of the minor (blue) points that hematin is used to help with the severe coproporphyria. I remember from the last season in episode 1 (Honeymoon), that the diagnosis there was AIP (Acute intermittent porphyria) and the treatment was hematin and, I think, glucose.
Is the glucose/hematin treatment standard for any of the porphyrias, or do they each have their own separate treatments?
Great job getting these reviews posted so quickly – really enjoy reading a medical opinion of the cases :)
-Bryan
December 3rd, 2008 at 2:37 am
>she never had symptoms with a low carb diet while trying to lose weight before her surgery.
As an overweight guy myself, I’m guessing that she (like the rest of us, admit or not) cheated on her diet rather regularly. She’s only human, after all. =)
December 3rd, 2008 at 3:02 am
The Monty Python geek is probably none other than Hugh Laurie, who was/is tight with the Pythons.
And I’d like to proudly announce that I was shouting at the screen, as well:
House: what else floats in water?
Me: Bread! Apples! Cider! Very small rocks! CHURCHES!
then, akin to sarah’s “yaaaaay!”, I actually pumped my fist when he said the duck line.
I’ve spent the last hour watching Python clips on their Youtube channel.
Just another reason to love House!
December 3rd, 2008 at 5:19 am
Hey everyone, greetings from Czech Republic.
Can pls somebody explain to me, why 13 has not been experiencing any symptoms of her diagnose? As far as I can remember it all started during the early half of season 4, where she dropped a file and House then persuaded her to get tested. But from what I’ve seen, her symptoms suddenly disappeared until now, when Forman told her, that her nerves have already started to degenarte. From what she said, she was not on any drugs nor she did any rehabilitation, so my question is, could Huntingtons symptoms just come and go away?
Thank you for your answer and to Scott for weekly reviews
Peter
December 3rd, 2008 at 7:18 am
House didn’t pick up on an actual symptom in season 4, more the fact that 13 over-reacted to dropping the file, since she was paranoid about symptoms. House said the explanation for the first time was that “people drop things”.
Since then she was diagnosed and had tests that predicted its progression but Foreman telling her in this episode was the first indicator of actual symptoms.
December 3rd, 2008 at 7:20 am
The Python reference was just great, so was House’s prank on Kutner and Taub.
The hooker, Cameron and Chase played along so well you could have thought that they were all professional actors!
Wait…
Gah, fourth wall confusion D:
December 3rd, 2008 at 7:37 am
I agree that it sounds like a phase III trial from the way Foreman describes it. That would mean that if it is any kind of decent quality study, it is randomized and double blinded, meaning that niether Foreman nor 13 know whether she is receiving the actual drug or placebo, unless Foreman is cheating and contaminating the study by ensuring 13 gets the actual drug. There could be an interesting side plot there, if the writers were smart enough to understand how the trial is supposed to be run.
December 3rd, 2008 at 7:42 am
Izzy, if Cuddy’s reaction puzzles you then I guess you don’t understand women. (Neither do I).
Cuddy was looking for a romantic gesture from House, not a clumsy grope.
“Logic” has nothing to do with love.
December 3rd, 2008 at 8:43 am
I was confused about Emmy’s sleep test. It looked like they had her hooked up to the positive-pressure mask that they use to correct obstructive sleep apnea, which doesn’t make sense if they were trying to observe apnea during her normal sleep. Or was the mask an oxygen senor or something similar? I had a sleep study done a few years ago, and while there were a ton of wires and sensors glued all over my head, there was no mask to speak of. Any thoughts?
I saw Kutner’s patient being an actress pretty early on in the show. I thought that House would be sitting on the bed when they pulled the curtain away in the ICU. Kutner’s business of providing second opinions based on patient-provided information seems like an excruciatingly bad idea. Even with his “not intended as medical advice” clause, it seems very ethically shaky (to say nothing of providing the advice fraudulently under someone else’s name). Maybe there’s a reason it’s illegal in 9 states? Have any of the doctors here heard of this sort of service?
Random thought: why didn’t House open up any windows or doors to air out his office after Cuddy’s hydrogen sulfide attack?
December 3rd, 2008 at 9:08 am
EngineeringDr:
None of the windows in my office building open at all, I guess the offices in House’s hospital are the same, for plot convenience.
December 3rd, 2008 at 9:18 am
After all the blackmail, I figure Kuttner is keeping 5% of the profits from SecondOpinion.com…
December 3rd, 2008 at 9:25 am
Official Comment
By my figuring, he’s getting negative 5%.
30% to Taub
25% to Chase
50% to House. That’s 105%.
December 3rd, 2008 at 9:30 am
>>After all the blackmail, I figure Kuttner is keeping 5% of the profits from SecondOpinion.com…
Actually Kutner has no reason to continue paying Chase or Taub, considering they were charging blackmail money to keep the info from House.
Don’t know crap about medicine but I really like this episode (and I like it even more now that Dr. Scott gave it his thumbs up on the medicine).
December 3rd, 2008 at 9:49 am
I Dont think Taub is going to get anything because, it was only black mail to prevent House from knowing. I dont think the deal was so he can help him run the service, and if house is ok with it, i dont really see any ethical problems as far as i can discern.
December 3rd, 2008 at 10:06 am
My initial calculations had him at -5%. But then I remembered that Taub’s 30% was to keep him from telling House. So that means that he is positive 25%
December 3rd, 2008 at 10:11 am
Re. the negative 5%
House did I think say that Kuttner still had to pay Chase (but how would he know about Taub’s cut?). It is the kind of thing that House would love to calculate and enforce, and I think we are supposed to add up 25 + 30 +50 and enjoy the result.
I found that whole plot amusing but seriously flimsy. First, that Kuttner would do something so unethical (not the website, the impersonation) as to risk his entire career, not just his job with House. Then, that he would assume it would attract the attention of random people who knew House’s reputation but not of House, Cuddy, the hospital trustees, etc. Kuttner is impulsive but is he that utterly thoughtless?
Re. the hand on breast, I think that if one compares the way House is interacting with the hooker in the last scene with his very formal, bored grope of Cuddy, even a guy might be able to see the insult intended and received.
Anyway, now we have an answer to the 5-season question why Cuddy always dresses like the wrong kind of professional.
December 3rd, 2008 at 10:35 am
Actually, he no longer has to give Taub or Chase any proceeds. Taub’s 30% was based on House not finding out. So since House knew all along, Taub doesn’t get his 30%. Chase’s 25% was based on Chase running the tests on the actress for Kutner. Since we now know that no tests were actually run, Chase doesn’t get his cut either. So I think both Kutner and House get 50%.
December 3rd, 2008 at 11:06 am
There were problems medically here with their whole response to both obesity and Gastric Bypass Surgery (GPS).
First, she “probably” had Type 2 Diabetes? Not so much. Obesity is the second biggest risk factor for Type 2 diabetes (after heredity) but that doesn’t mean that most fat people have it (it’s a logical fallacy).
Second, you can’t undo GPS. It’s not just that the stomach is reduced in side, huge portions of intestine are also removed (hence the risk of SIBO). Unstapling does not restore the intestine. It’s a one-way street.
They should have detected gastric bypass by looking at her skin. Either she has skin flaps from extreme weight loss, or she has scars from repairing those flaps (a tummy tuck, arms, and breasts would be typical).
Why didn’t they consider this disease earlier, once they knew about the bypass? Isn’t it a known complication of bypass?
December 3rd, 2008 at 11:17 am
Peter Kovar: The symptoms 13 showed in season 4 were faked by House – he switched her from decaf coffee to regular, giving her the shakes as a side effect of the increase in caffeine. Until recently, she’s never demonstrated real symptoms.
Karl Withakay: In the episode with the little boy that thought he was being abducted by aliens, Chase tells the boy “Those windows don’t even open. They’re just there to let sunlight in.”
December 3rd, 2008 at 11:46 am
House groping Cuddy perfectly represented how he interacts with people – casual sex, he’ll flirt. Meaningful relationship? Misdirect, inappropriate humour, games, and making them fight for it. Cuddy was disappointed that she didn’t get the ‘real’ reaction she wanted (instead, a grope), but the desk was an indication of what House really felt (and all the more meaningful to her because it was anonymous – in House’s terms, that’s a sincere compliment). People think House is an ass and that’s the end of – he’s not. He just does what (he thinks) is right rather than what’s nice. He has never killed a patient due to lack of trying, he always works hard to cure them, and if he has to manipulate them into doing the ‘right thing’, fine. Not medically ethical, but perfectly acceptable to an “ends justify the means” ethecist.
December 3rd, 2008 at 11:50 am
Great episode. Looks like House is hitting its groove again after a somewhat rocky start.
I’m surprised no one mentioned House’s The Untouchables reference (”he sends one of yours to the hospital, you send one of his to the morgue”). I was on the floor.
December 3rd, 2008 at 12:11 pm
I really enjoyed the episode too for the soap opera returning to its best standard, with the great one-liners, and because I had experience with the medical side (even if I have no idea about the accuracy etc. of the diagnoses).
+ I could easily see House “ego surfing” his name through Google and discovering the “second opinion” web site.
+ I just had a flu shot yesterday, and having Guillain-Barre was contraindicated for receiving the shot in the release form. I joked with the nurse about ‘is that the one where you swear uncontrollably?’ and she laughed and said, paraphrasing, that it was a nerve disorder.
+ I have sleep apnea and so have had a sleep test before so I think that they should have noticed earlier, despite being preoccupied with the Second Opinion case, that she had left the room. In my test from some 4 years ago, I was hooked up with alot (12?) of electrodes hooked up to the monitor and if even one of them popped off during the night, the nurse was in right away to re-apply it. So I’d have thought that her removing all 12 of the electrodes and the mask and leaving would have been noticed sooner. But while her having the night terrors nightmare of her overweight clients crushing her was pretty obvious, the sleep apnea questionnaire I filled out included night terror questions, so I figured that it fit in with a potential apnea-related diagnosis well so I didn’t look at it as being gratuitous.
+ I was a bit perturbed at what I took to be an anti-Republican comment re. healthcare, but they made up for it with the Biden-esque reference to Foreman being “clean and articulate” later on. [I don't mind political commentary in entertainment assuming it's not being made gratuitously for propaganda purpose and is genuinely funny--like House's funny "wide stance" comment from a few years ago--or when they mock both sides equally, which is something they did in this episode.]
+ I was also saying the Python ‘duck’ lines to myself and also offered my own differential diagnosis of the patient being made of wood.
+ It’s good to know that I’ve been self-medicating against coproporphyria for years.
+ I figured that the hooker was faking death on the slab because it was too brutal an ending for a plot line that they hadn’t been paying alot of attention to, but I didn’t know how deep the conspiracy was, which was a pleasant surprise.
+ And speaking of plot lines, this one had a bunch that made the show very interesting instead of the usual TV standard of one main plotline and one or two subplots.
So, really good work this episode. Alot of fun.
December 3rd, 2008 at 12:25 pm
I’ve done this as a separate post as I don’t know if providing outside links is approved of here (so feel free to delete this if I’ve made an error in posting, Scott), but here’s a funny item from the Cracked comic site “Every Episode of ‘House’ Ever” ready for anyone who wants to give writing a script on their own a try:
http://tinyurl.com/5k4ehv
WARNING: there’s no really foul language or questionable photos used in the comedy piece itself, but the language used in the attached comments section is Not Safe For Work.
December 3rd, 2008 at 12:31 pm
Either she has skin flaps from extreme weight loss, or she has scars from repairing those flaps
I forgot about that, Deborah. Yeah, I thought of that too based on what I had seen, ironically enough, in a Nip/Tuck episode.
December 3rd, 2008 at 12:33 pm
Thanks Michael, that’s what I was trying to say.
December 3rd, 2008 at 1:37 pm
To Scott -
Official Comment
By my figuring, he’s getting negative 5%.
30% to Taub
25% to Chase
50% to House. That’s 105%.
Taub and Chase had nothing to blackmail Kutner on after House announced that he knew about it so Kutner gets 50% and House gets 50%, not a bad trade-off.
Also, why weren’t Kutner and Taub paged when their “patient” supposedly coded? Guess they didn’t think about that.
December 3rd, 2008 at 1:46 pm
Hi! Somebody here can please me explain what is the GRC, where Foreman and Thirteen was doing the clinic trial thing?
I cannot find out what GRC stands for…
December 3rd, 2008 at 2:14 pm
Thanks so much for these reviews, Scott! I learn so much!
Count me in as another Monty Python geek. When House said “What else floats in water?” I immediately yelled at my TV “A duck!”
And I was very tickled that I was right.
Then, like Jason, I spent the rest of the scene finishing the other things that float in water (”Bread! Apples! Cider! Very small rocks! Churches!”) And, like Andy in Toronto, I was amusing myself for the rest of the scene, doing a differential that POTW could possibly be made of wood.
I didn’t catch too much else of that scene. But I amused myself.
I love it when “House” is funny. And I thought this one was a riot. Between the prank wars (I knew House knew about Kutner’s web site, but I still loved that plot’s ending) and the warfare between House and Cuddy (and I went “Aw!” at House getting Cuddy’s med school desk for her.)
I was amused by the nightmare. I might be an evil, self-hating person (I’m also overweight), but I laughed so hard at that.
Kat
December 3rd, 2008 at 2:15 pm
I just wish once in a while they’d give women in Cuddy’s sort of situation a sense of humor. Anyone who’s going to be with House needs one. (And yes, in her shoes, I’d have laughed uproariously.)
wg
December 3rd, 2008 at 2:26 pm
Count me in as another Monty Python geek. When House said “What else floats in water?” I immediately yelled at my TV “A duck!”
My tag line on my email at work is “Ah, but can you not also build bridges out of stone?”
No one gets it.
Which makes it even funnier.
December 3rd, 2008 at 2:34 pm
You missed an error. Someone mentioned that she probably had Botox to tighten up the loose skin left from being obese and losing all the weight. As I’m sure you know, Botox doesn’t tighten skin, it simply paralyzes the muscles that pull the skin, temporarily preventing them from forming wrinkles.
December 3rd, 2008 at 3:16 pm
Well, as long as we’re all on the lookout for pop cultural references in this episode, how about House’s response to Cuddy’s spilling of hydrogen sulfide in “their” office?
“Cunning plan.”
Which I understand is some kind of reference to “Blackadder,” which makes me wish I’d seen it.
December 3rd, 2008 at 3:23 pm
Is it just me or is something other than “big brother/naughty little sister going on between Foreman and 13?
December 3rd, 2008 at 4:33 pm
House did hint at his knowledge of Kutner’s website, when he tried to get Emmy to eat more cake:
“Not a lie. Not an attempt to defraud in any way. It’s an actual licensed physician with an actual diagnosis.”
December 3rd, 2008 at 5:45 pm
Deborah –
As a medical student who was worked with the surgical service on gastric bypass cases:
1. There is a short bowel post-surgery; however no bowel is actually removed in the most common kind of gastric bypass (called a roux-en-y). The stomach is connected lower down on the intestine forming a Y, with one branch of the Y going to the stomach and the other (which previously connected to the stomach) getting tied off. The operation is *technically* reversible, although it is difficult and uncommon.
2. Skin elasticity is a function of age, meaning that younger people who were not very large to start with may not have extra skin after the operation.
So overall, plausible
December 3rd, 2008 at 5:48 pm
D-r Bulgaria: In the Lucky Thirteen episode, Foreman actually seemed to care (a bit) about Thirteen’s self destructive lifestyle, which is a bit out of character for him. Their scenes together in the last 2 episodes, while brief, have been a bit less subtle. I think the House/Cuddy thing is blowing up so fast so we pay attention to them while they quietly develop a relationship that might actually happen sometime soon.
December 3rd, 2008 at 6:19 pm
Triple hurray for a Monty Python reference AND a Blackadder reference in one House episode! :-D
I would soooo like to see an outtake on Season 5 DVD where House asks “What else floats in water?” and Kutner and Taub start saying “Bread! Apples! Cider! Very small rocks! Churches!” And of course they should deduce that the patient was a witch and had to be burned. :-D
December 3rd, 2008 at 7:59 pm
Definite kudos for the Monty Python reference… I was hoping to see House check if patient weighs the same as a duck.
Cuddy mentioned the cold weather contribution to the exercise induced asthma, my experience with asthma has been just the opposite, cold weather doesn’t necessarily relieve the attack, but eases the discomfort.
December 3rd, 2008 at 8:09 pm
The windows don’t open, but what about the door to House’s/Wilson’s shared balcony? That would’ve aired out whatever Cuddy “spilled”…
December 3rd, 2008 at 8:28 pm
House did not give the desk to Cuddy.
Wilson did.
He’s trying everything he knows to get House and Cuddy together.
The episode was great. I like all of them.
Great reviews btw.
Heishiro
December 3rd, 2008 at 8:34 pm
I love reading your reviews of House. I got into an interesting argument with a friend today about whether or not a doctor should know the medicine or is allowed to look it up. Since everyone in House seems to know pretty much everything about any disease I was wondering whether you actually had to look up the medicine before writing the reviews. Or is that something that just becomes second nature after a while?
Either way, compliment on your website.
December 3rd, 2008 at 9:16 pm
Official Comment
Don’t trust a doctor who never has to look anything up. We all have to do it from time to time — we just try not to have to look things up in front of the patient.
Good medical training means you have to look fewer things up (and usually relatively minor things) — and you know where to look to find them. On a given episode, I probably know 75-80% off the top of my head, the rest (usually the obscure genetic diseases) I have to look up. I tend to double check what I think are big mistakes, even if I’m pretty sure myself.
December 4th, 2008 at 12:24 am
hearts: My sentiments exactly and plus the pattern was pretty obvious if you ask me – Foreman: tight up, straightforward never making anything wild seemed mesmerized with 13 wild behavior. The fact that both House and Chase dubbed him boring might have helped there as well. He may even not be sensing it but he wants in in the “wild” part of 13 while he also wants to straiten her up make her more like him. I see far less reasons for 13 to like Foreman, except the fact that she may do him just because she is feeling frisky. Or may be she will be gratefull for the care? (Women always seem to fall for the bag boys, or for the extremely good ones?!?)
Heishiro: Do you know this for a fact or are you just speculating? It does make sense though (and it is so very disappointing I practically loved the idea of a concealed romantic gesture from House after the groping part…
December 4th, 2008 at 1:46 am
Scientific research has shown that CPR is best done to the beat “staying alive”
Which house did not do….tsk tsk.
December 4th, 2008 at 9:19 am
Keith: my experience with asthma and exercise fits what Cuddy suggested. In cold weather, my asthma attacks seem less severe (maybe the cold reduces the inflammation in my lungs?) but they come on much more quickly, and last longer. I find it harder to breathe in general when I’m cold to the point of shivering than when I’m at a normal temperature.
December 4th, 2008 at 9:39 am
@ Julian Hsu – I also loved the Untouchables reference. A Brit playing an American doing a Connery impersonation = hilarious accent. :^)
As “nonlinear” as the House / Cuddy relationship is supposed to be, I can’t help but think that one of Cuddy’s higher-ups would catch wind of it and make them break it off – it has favoritism/lawsuit written all over it. Oh well, I guess I can let it go.
December 4th, 2008 at 9:57 am
I don’t believe Wilson arranged for the desk. I’m pretty sure House did. And he did it with no fanfare because he is certain the truth will come out. Just like with the broken desk drawer.
House has a big ego, but not surprisingly, insecurity and low self-esteem. He is always unsure (except with Wilson, who seems to love him unconditionally) of personal interactions and relationships. This is a source of constant irritation and internal conflict. The fact is, he has a big heart as well. He’s just not skilled at showing it: He’s been a brainy loner all his life and strikes out by blowing everybody away with his brilliance. Why else would he care so much and be so observant about what the people around him are up to if he somehow didn’t want “in?”
No, I think House got Cuddy’s old desk, and I also think he used the remaining 3 hours he paid the ‘thespian’ to put on the little act in his office purely for Cuddy’s benefit. Not sure where this will go, but, the producers have said that the Cuddy/House relationship will not be “linear.” Whatever that means…
Uncle Ron
December 4th, 2008 at 12:32 pm
Any chance of the patient being named “Emmy” being another in-joke?
As for House’s rather passionless grope of Cuddy – he usually goes for her behind. Is “moving up” symbolic of him thinking more about a romantic relationship with Cuddy? Usually his only physical contact with others is when he pays them (hookers) or is wearing gloves (patients). He’s testing Cuddy to see what she’ll allow, and what he can tolerate emotionally.
—Kimberley
December 4th, 2008 at 3:33 pm
Exercise-induced asthma is caused by hyperresponsive airways and an attack can be triggered when the airways get dry. Cold air has lower humidity and can cause an attack, especialy while exercising (and therefore breathing heavily).
December 4th, 2008 at 7:54 pm
Quote: Do you know this for a fact or are you just speculating?
Answer: I’m speculating on that.
House is insecure and all of that, but his personality makes him “not romantic” at all. And Wilson is his enabler. Wilson is telling him and Cuddy to get together on every episode since they kissed. Even he tried to tell Cuddy that he had feelings for her, trying to make House jealous as the final objective.
And what a big coincidence!!! Wilson is the one that likes the desk and makes a comment when enters the new Cuddy’s office… Really convenient.
So, i don’t see any reason why the desk couldn’t been ordered by Wilson, not House.
Only time will tell.
Hope it does soon enough.
Heishiro.
December 4th, 2008 at 10:31 pm
okay I have a question- not about House. My Friend Bob was diagnosed years ago with “excersize induced asthma”- did excersize: mowed the lawn, hoed the garden, whatever, started to wheeze, got woozy.
not much of a surprise, our town has the highest incidence of asthma in the province due to nasty petro refineries. anyway 10 years pass bob flinging about with his inhaler & then bobs doctor finds out its not asthma- the lining around his heart has calcified & this is what caused his wheezing & woozy problems.
So Scott, being knowledgable about such things- i’m curious- can that *do* that?
December 5th, 2008 at 12:56 am
Chemical comment: Hydrogen sulfide is a gas, not a liquid, and I can’t fathom why it would be stored in a culture tube. It’s also incredibly poisonous (very hazardous at 100 ppm) and would be a lousy stink bomb because the nose quickly adapts to the odor. Pyridine or ethylene sulfide would be easier and safer and might even be available in a research hospital laboratory.
December 5th, 2008 at 3:36 am
I must say I liked House’s “troubles in the Land of False Hope?” line, probably because I don’t get most cultural references :) I found the girl rather uninteresting if you ask me. I’d like to see a 3D patient for once! Like the North Pole girl (or South Pole)!
December 5th, 2008 at 5:07 am
Wilson didn’t send the desk, because he could not have known about it, whereas House and Cuddy studied together (even have some history back there), so House is mroe prone to remember about her desk.
Also, it is pretty nice gesture that they used atual Huntigton’s patients on the show. I worked in a Huntigton’s oriented nursing home before medical college and there is never enough recognition for the one most dramatic diseases (because of late age on of onset and it being autosomal dominant)
December 5th, 2008 at 12:38 pm
MrKhil, you’re right House had Cuddy old medical school desk from her mother. But there is no evidence that House and Cuddy studied together. Recall from Humpty Dumpty Cuddy was still in college when “House was already a legend”
December 5th, 2008 at 2:48 pm
Heh! Nobody else noticed this doubtless deeply significant clue: all the guys had recent haircuts! At least, House, Taub, and Kuttner.
I wonder if they shot this scene after a few weeks’ break, so everybody came in unkempt . . .
December 6th, 2008 at 3:20 am
I am not surprised at their ending, from all respects. If House and Cuddy get together, this show is coming to an end.
However, by that, I don’t mean that the ending will feature the two coupled or 13 quietly dead, they are equally likely to leave it open ended.
What I do mean is that you bunch of idiota need the “curve” to gossip and gossip.
December 6th, 2008 at 7:39 am
Hi
I’m one of the fans of House MD , i have watched all he previous episodes.
the episode this week were similar to another episode in season 2 or 3 when house ex-wife husband was ill and he was diagnosed as porphyria
thanks for your nice reviews
December 6th, 2008 at 9:11 am
Debbie: You are right but not completely. I don’t have the episode atm, but if i recall correctly Cuddy said that by the time they graduated from college, House was already a legend.
December 7th, 2008 at 12:53 am
From the For-Whatever-It’s-Worth Dept.: Apparently, they filmed a scene showing Taub and Emmy in the hospital cafeteria indulging in chocolate cake, but it obviously didn’t make the final cut:
http://us.imdb.com/media/rm1403950336/tt1273713
Wonder if it’ll be included in the DVD (either in context or as an extra).
December 7th, 2008 at 7:46 am
Emmy didn´t look like she´s having a porphyric attack (remember Mark?). Right, attacks in HCP are milder than in AIP, but she didn´t really exhibit the typical symptoms and there was no mention about photosensitivity. Btw. we´ve already seen 3 types of inherited porphyrias, what about the acquired, esp. drug induced, ones? I also think that pseudoporphyric reaction due to eg. naproxene would be great! I was surprised how OK Thirteen was after her kidney failure last week. I´m still wondering whether she dies somehow or will be cured by Foreman´s meds??? Good ep, either
December 8th, 2008 at 1:02 am
Just tried secondopinion.com. It redirects to Microsoft Internet Services 7 o_0
December 8th, 2008 at 4:02 pm
[...] Insomma, che dire di più? È stato uno dei migliori episodi della stagione, senza clamore ma con tanto ritmo ed equilibrio. Ed anche dal punto di vista medico pare essere abbastanza accurato. Quattro e mezzo sicure. [...]
December 9th, 2008 at 12:35 am
Excuse me. Thats very annoying. Could you post in English please??? I believe the majority of readers here are NOT fluent in Italian.
December 9th, 2008 at 6:20 am
ciao~
December 9th, 2008 at 3:09 pm
Personally, I feel it’s very annoying to end a question with three question marks. I mean really, are you adding that much more mystique with only two additional key strokes?
Secondly, I don’t feel that italian is particularly annoying, only that I had to use a translator which threw a barrage of pop-ups at me to find out that the post was simply saying they liked the episode. These were no ordinary pop-ups either, they had the network stopping power of a .357 slug. Luckily I was wearing my bullet proof cup.
Lastly, am I the only one here who just didn’t appreciate the episode as much as everyone else? I mean, I’m not out to blast this series or this season, but I just didn’t take it in the same as most. Well, MrBuddwing seems to be with me, but for totally different reasons (I know, Cuddy’s blouse cut is a little low, but hard as I try, I just can’t find any reason to take offense). I appreciate that they got their facts a little straighter considering 13’s Huntington’s diagnosis, as I’ve read here from a few people unfortunate enough to have experience with Huntington’s. The medicine was decent, by Scott’s accord not mine, so that’s a plus. Still, I just felt like the whole House/Cuddy reactions were just playing on information that we already knew. We know that House is looking for was to dip her pigtails in the nearest inkwell, even Wilson spells that one out. I didn’t really identify with the patient or her illness, which I can’t really criticize, but still the whole thing just made for an average episode for me. Not great and not poor. But I’m still waiting for 13’s inability to cope with her mortality to turn her to the dark side. Don’t ask, I have no idea how it would play out, but I’m looking forward to it when it does.
December 10th, 2008 at 12:27 pm
As this is a primarily english speaking forum, and not a “speak any language you want here because we are all fluent in everything” forum, it would be appropriate for everyone (not just him) to not to make an entire post consisting of a foreign language. It just really makes no sense and shows a bit of lack of consideration for the other readers on here. That person can obviously read the English language, else they wouldnt be positing to this site (unless they just wanted to screw around.) Traditionally however, in the U.S., people are not bilingual in English and Italian. I am sure there is no lack of Italian websites he can post onto if thats his preferred tongue. Its just silly to do it here, and I’m sure everyone else agrees with me (or doesnt give a shit.)
I’m not a damn xenophobe, just making a simple point. And my point stands.
is that clear enough for you??????? (oops, was that too much punctuation for your delicate reading pleasure? Get over it. )
December 10th, 2008 at 3:09 pm
Oh man, I honestly thought that I’d never be a mulit-question mark kind of guy. Two or three question marks justs seems annoying, but you strap seven of those bad boys together and it’s like seeing colors I’ve never seen before =).
Look, I agree with your point, it’s a little rude to post an Italian message on an English speaking forum. As I’m betting that we don’t have a collective second language amoung us, we couldn’t really benefit from “any” non-English messages. I mean, we’re here to talk about House, not learn how to say “hello” in Mandarin. So I apologize for using your grammar .. creativity, as a segue into my post. My intentions were pure, I swear I was just trying to be witty (emphasis on “trying”). But to be honest, I was bored and I was hoping to get some new insight into the episode by translating … whoever’s post that was. It was kind of exciting. But of course, I was thoroghly let down.
On a different note, I should be studying for some professional exams but I noticed that Scott just gave this weeks episode (Joy to the World) good marks. So instead of learning about routing protocols, I’m hoping over to ITunes to get my fix. I suppose in the interest of education I could just read the review and hit the books, but I’ve never been big on hitting books. I mean, they’ve never done anything to me, so what’s with the violence?
December 11th, 2008 at 7:50 pm
Hey, just had to post after watching this episode on Hulu because this was one of the most enjoyable House episodes I have ever watched. I am not positive if it was the very interesting storylines, funny pranks, or the British comedy references.
The funniest prank to me was not the back and forth between Cuddy and House, although that was great, but the big one he played on Kutner and Kal. That was BRILLIANT and I laughed my rear off when that girl popped up off the table. Especially because Kal Penn’s character has been diagnosing so well lately, almost like he has been rivaling House as a differentialist. So to see him shown up like that was hilarious. Don’t get me wrong, KP is probably my favorite of the new team members, but that was classic.
I know a lot of viewers got the Monty Python reference which was great to hear, but I am also glad that someone also noticed the Blackadder reference which was more subtle. Can anyone name it ?
Anyway, overall this episode was very light hearted and humorous (except for 13, which was still positive in a certain way), and I enjoyed it very much. I guess the move across the pond to the States has been good for Lord Laurie.
Regards,
Dig Dug
December 14th, 2008 at 12:24 am
Two opinions:
1) House touching Cuddy’s breast: House seems to have some pretty heavy issues about women – or anyone – having control over him. He broke up with his ex for OKing surgery that he wasn’t OK with…but who else OK’ed it? Cuddy. Cuddy is not only his boss but was calling the shots in this scene until the hand-on-breast move and had even told him what he was supposed to do next (paraphrase: I think the next step is that you kiss me). House’s next step was to take the power away from Cuddy in a way that understandably disgusted her, even though it WAS somewhat predictable to us watchers.
Opinion #2: The people calling for English only on this site are not speaking my language, even though I speak English. I respect your right to share your opinion. I’m just sharing mine here as well.
I am personally very OK with posts that I don’t understand popping up on this forum. That happens sometimes even when the posts are in English, since I’m not on to my clinicals yet. Posts in other languages take more energy to decipher, but who said anything worthwhile was easy? I like learning more languages since that expands who I can talk to.
If Scott decides to boot all non-English speakers I’ll respect that. The forum belongs to him more than it does to any poster or category of poster.
Great to learn what causes the purple urine. A doctor friend of a friend kept a vial in his car for years (probably not professionally kosher) just because he loved to show it to people.
December 14th, 2008 at 1:17 am
Official Comment
For the record, I have no problems with non-English speakers; it is the “world-wide” web, after all. What the people concerned about the Italian have failed to recognize is that it is a trackback from an Italian website, so it’s only logical that it’s going to be in Italian.
December 15th, 2008 at 5:02 am
To EngineeringDr, who said:
“I was confused about Emmy’s sleep test. It looked like they had her hooked up to the positive-pressure mask that they use to correct obstructive sleep apnea, which doesn’t make sense if they were trying to observe apnea during her normal sleep. Or was the mask an oxygen senor or something similar? I had a sleep study done a few years ago, and while there were a ton of wires and sensors glued all over my head, there was no mask to speak of. Any thoughts?”
I also had a sleep study done years ago (and it turns out I do have sleep apnea). They did a few hours with me hooked up to assorted sensors, then when they’d decided that it looked like I did have sleep apnea, I got a few hours with positive airway pressure. No doubt sleep labs vary, and I’m pretty sure the techniques vary over time too. But anyway, I agree that it did look like a positive-pressure mask; maybe they had given her a few hours with just the sensors, but we didn’t get to see that?
December 19th, 2008 at 7:55 am
As Scott said, it’s a trackback. Besides, how ****** difficult is to use Google Translate or a similar service? Those tools are made so that people who wouldn’t understand each other otherwise have a chance to communicate.
December 30th, 2008 at 12:25 am
Shouldn’t have Kutner got the Monty Python reference? He does seem like the kind of guy who’s a fan of them.
January 22nd, 2009 at 9:04 pm
I thought I’d just mention, that Lori Petty is most famous for her role in the film Tank Girl. In case there are people who don’t recognize her name.
February 4th, 2009 at 6:04 am
Just finished watching this episode in Aus (yep, we’re a bit behind here)
The sleep study was atrociously done. Yes she was wearing a CPAP mask – looked like a full face Respronics to me. Instead she should of had a nasal cannula and/or a thermistor. She was never diagnosed with sleep apnoea so there was no reason for her to be wearing the mask. Even if she was, she didn’t look like a mouth breather so a nasal mask would of been more appropriate to reduce the chance of leakage from the mask.
Also when Kutner and Taub notice that her EEG is flatlining there would be a lot more than just her EEG, there’s respiratory effort x2, ECG, EOG, EMG, airflow, SaO2, and generally leg movements too. It would of taken her a lot longer than the short time the guys were talking for her to remove all the sensors involved in a sleep study.
June 26th, 2009 at 11:15 pm
The attack of the fat people hallucinations was more funny than anything else. Although Left 4 Dead players might be a bit unnerved as they resemble Boomers when they swarmed her, and Louis and Zoey were elsewhere in the hospital for the Huntington’s dealy.
Also, if you’re not a moderator than why do you care if someone posts in a language that isn’t English? Just move on to the next post.
September 3rd, 2009 at 7:41 pm
Re-watching the episode, I just noticed another oblique reference I didn’t see mentioned above: Just before the “What else floats in water?” reference House says: “I ‘m doing my famous Socrates impression – think I really nailed the accent”…
September 28th, 2009 at 5:48 pm
I must be missing something…if a patient doesn’t have a pulse, how can she have any rhythm?
November 13th, 2009 at 3:31 am
I’m another one of those people who lives in a country that gets _House_ a year or so behind the rest of the world. To be honest, I liked the _Blackadder_ reference better in the episode where *Cameron* says that she has a cunning plan. Especially since in the _Blackadder_, it was always Baldrick, not _Blackadder_ or one of Hugh Laurie’s characters, who came up with the supposedly cunning plans.
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