House — Episode 12 (Season 5): “Painless”
It’s nice to have House back after the winter break, but I wish the second half of the season had started with a stronger episode, not this lukewarm time waster.
Jeff is a 32 year old patient with a 3 year history of chronic pain. It started as abdominal pain, but now he also has severe headaches and muscle cramps that come and go. He has seen seven specialists since his symptoms started, but a cause has never been found. He is on high doses of narcotic pain medication with poor pain relief. As the episode starts, he writes a farewell letter to his wife and son and tries to commit suicide, but they come home unexpectedly and find him. He is rushed to the hospital where he is admitted to House’s team.
Thirteen suggests fibromyalgia, but the idea is quickly shot down as Jeff’s symptoms do not match the recognized criteria of the condition. Taub suggests that the patient’s pain is psychosomatic, probably due to an undiagnosed depression. House has Taub run a “pain profile” (i.e. depression screening) on the patient, and Foreman and Thirteen search his house. The search turns up some metal polish — which can cause nerve damage (but the patient worse wore a respirator) — and a freezer full of quail. Quail-related food poisoning (coturnism) can cause rhabdomyolyisis (a disease caused by rapid muscle breakdown). Taub continues to think that the pain is psychosomatic, but House disagrees, believing that Jeff’s depression is caused by the pain and not the other way around. He orders a muscle biopsy to rule out rhabdomyolysis.
In the middle of the biopsy, Jeff complains of sudden right arm pain and his blood pressure drops dangerously low. Kutner announces that he is in “arrest” — though whether it is a cardiac arrest or a respiratory arrest is never clarified (though later comments suggest it was a respiratory arrest). He is found to have a pulmonary embolus by a ventilation/perfusion scan. The differential includes a hypercoaguable state (patients that clot easier than normal) or a cancer syndrome (Trouseau Syndrome is mentioned). Since House is not around, Foreman orders a CT scan of the patient’s chest, abdomen, and pelvis in an attempt to find a suspected tumor. No tumor is found, but edema (swelling) is seen in the intestines and air is seen in the intestinal blood vessels. Kutner suspects that Jeff may have a blockage in his superior mesenteric artery which has blocked blood flow to the intestines and damaged then. Thirteen points out that blood clots elsewhere in the body may be causing his pain. Foreman orders an angioplasty of the artery. Hearing the symptoms, House intervenes and points out that the patient had blown air into his IV, causing an air embolus in a suicide attempt. This is what caused the intestinal edema, air in the intestinal vessels, the pulmonary embolism, and respiratory arrest.
The differential now includes non-motor seizures (discounted because the EEG’s have all been normal) or a glycogen storage disease (an inherited enzyme deficiency) such as McArdle’s Disease. An ischemic forearm test (a test designed to uncover the enzyme deficiency) is performed. It doesn’t show any evidence of the glycogen storage disease, but during the test the pain moves from his left arm to his left leg, the first time that it’s ever jumped like that. The possibility of disc disease is mentioned once, then never again. The team now wants to decide once and for all whether it is psychosomatic pain or there is a physical cause. A total spinal block, high in the spinal cord, is given. This is supposed to separate the mind from the body. If the pain is gone, then the cause of the pain is physical (because the connection between the nerve ends of the body and the pain areas of the brain has been broken); but if the pain remains, then the cause is in the brain (because it doesn’t involve nerves of the body, thus breaking the connection would have no effect). The test relieves Jeff’s pain, but not entirely. This puzzles House because the test results should be all or nothing.
A short time later, House and his team are called to the floor when Jeff’s son Zach starts writhing on the floor, screaming in pain. Jeff’s wife is scared that Zach may have what Jeff has, but House recognizes it as a distraction to cover Jeff’s latest suicide attempt — drinking a bottle of isopropyl (rubbing) alcohol. He is started on dialysis. With the failure of the spinal block to clearly identify a cause, the team now considers Fabry’s Disease (another inherited condition), syphilis, or opiod induced pain (his pain medications are worsening his pain). House decides the last is the most likely, and forces narcotic withdrawal in the patient by giving him naloxone, an narcotic blocking agent. It doesn’t work, and Jeff’s wife convinces House to let Jeff be discharged home with the understanding that he is going to attempt suicide again once he gets home; this time with her blessing.
A short while later, talking to the handyman who is fixing his apartment, House has his “Eureka!” moment and deduces that Jeff has epilepsy (yes, I know they dismissed the idea earlier, but bear with me here). It started three years ago as a seizure in the muscles of the testicle but then spread to the brain’s sensory region and somehow “rewired” the neurons of the brain. It didn’t show up on EEG, House says, because the nerves to the testicular muscles are in the “deep” area of the brain. With treatment for his seizures, Jeff is cured and lives happily ever after.
This seemed to me to be a relatively weak episode medically. There aren’t many specifics I can point at and say they got wrong (but not much I can say they got right either); it’s more of an overall impression. Part of the problem is the vague symptoms — is the patient’s pain all over (as frequently stated) or specific to certain areas (as it seemed to be whenever the plot required). Admittedly, chronic pain conditions are difficult to diagnose and treat, but this was a little too much.
As usual, major complaints are in red, minor in blue, nit-picking in green:
While the testicles may be “deep” in the body, the nerves for the muscles controlling them are located on the motor cortex, just like all the other skeletal muscles in the body. They are not too deep for EEG.Somehow these seizures “rewired” the pain sensors in Jeff’s brain — but apparently only temporarily as the pain keeps moving. If they’re rewired you’d think they’d stay rewired rather that spontaneously un-rewiring.Since this was a brain-related cause of pain, shouldn’t the spinal block have had no effect, not a partial one?Some of the most common medications used to treat chronic pain are seizure medications. You’d think one of his seven specialists would have tried them at one point.As is becoming more common, the diagnoses suggested are way off from the patient’s actual signs and symptoms. McCardle’s Disease, Fabry’s Disease — really?
I think it’s pretty clear that neither Foreman, the nurses, nor the writers have any idea what a double blind experiment actually entails.
Speaking of no idea, Cuddy’s right: the team (and floor nurses) seem to have no idea what “suicide precautions” are. What were they, 0-2 for the night?
The medical mystery was one of the least interesting cases yet (if not the most boring in 5 years), so deserves a mere D, and just because I’m feeling generous. The final solution hurt my mind trying to understand, and earns another D. The medicine was scattershot and unenlightening, but not much worse than the season’s average so earns a C-. The soap opera was…adequate, barely. C.
The most damning thing I can say is that there were no great House lines or moments that made me chuckle — for the first time ever.
Last week’s House review
A list of all prior House reviews
January 19th, 2009 at 11:34 pm
When House burned his kitchen ceiling and didn’t manage to damage his own pipe, that didn’t make you chuckle, not even a little bit? And Wilson’s giant yellow bird, that was good for a chuckle (but granted it wasn’t a House moment, as such).
Agreed on the medical case. Kind of boring, and when the little boy argued in favor of letting his dad die, that was all kinds of messed up. I also didn’t like how the wife insisted it was time to take her husband home to die, since they had been in the hospital for a whole 4 days. The man’s apparently been in agonizing pain for 3 years, and here you’ve got a doctor who is committed to figuring it out, and you want to give up after 4 days? Come on.
January 19th, 2009 at 11:35 pm
“The last time that happened, I got shot.” Hahaha…
Nice reference to old episodes.
January 19th, 2009 at 11:36 pm
It might have been some sort of reference to how “deep” down the central sulcus the regions of the sensory and motor cortex related to the genitals are, but I never heard of it having any significance on an EEG.
Yeah, this episode wasn’t the worst qualitatively. But it sure was dull.
January 19th, 2009 at 11:46 pm
The seizures were supposed to have rewired his brain? I missed that, I thought seizures in his brain were causing his pain.
I’m no doctor but I also wondered why no one had ever tried putting him on anti-convulsants, since they’d tried everything else.
Was the final diagnosis the same or different than what Thirteen suggested at the beginning?
As for lines, Taub’s reference to the sub-committee on world domination was a good one.
January 20th, 2009 at 12:05 am
Official Comment
While there were some modestly humorous lines, there were no LOL moments, and so far every other episode has had at least one.
Dan, what I found most interesting about the scene you mentioned was, that if House was telling the truth about why he singled out Foreman, he was setting him up to be shot.
January 20th, 2009 at 12:07 am
uh, the basic concept works. the testes are represented way down deep in the inter-hemispheric cleft. as a result, this area is poorly seen on routine eeg. and repeated painful seizures do in fact lead to a chronic pain syndrome. “re-wire” may not be precisely correct but it’s not far off.
January 20th, 2009 at 12:20 am
100% agree with you Scoot.
That was the first time I’ve been completely bored while watching a House episode.
I really hope they turn it around, season 5 so far a basically been a let down,
January 20th, 2009 at 12:21 am
*I mean Scott
Sorry had to fix that, don’t want you thinking I think your name is Scoot.
January 20th, 2009 at 12:29 am
From ‘a neurologist ‘:
“inter-hemispheric cleft”
Ooops, not sure why I said central sulcus. Im weetawded.
January 20th, 2009 at 12:30 am
(Not medically relevant.)
I did chuckle, softly, at the end when House figured out he did in fact break the pipe by using the shower supply to lower himself into the bath. “I’m not happy; I’m right,” or something to that effect, except, whoops, not quite.
I have to say I’ve been disappointed since about half way through the third season. But if there’s anything better on TV than subpar House I’ve yet to find it.
January 20th, 2009 at 2:48 am
Yeah, I was annoyed when the nurse gave away that Thirteen was on the placebo. So much for a double-bind trial! Especially since we, as the audience, know what’s going to happen- Foreman’s going to switch the placebo with the real thing. Ugh!
And Cuddy choosing Cameron to take over her job? What. The. Hell? Shouldn’t she pick someone who, oh I dunno, actually has experience as a hospital administrator!
January 20th, 2009 at 3:26 am
It was really a dull episode.
I found some non-medical details really bothersome – like the plastic doll that was supposed to be Cuddy’s baby. It was more than unnatural to see Cuddy stuffing a pacifier into a doll’s mouth… for the budget of theirs it shouldn’t have been that much of a problem to have a baby for a 2 min shoot (if not less).
January 20th, 2009 at 4:00 am
I liked his “Fourteen is right” line
January 20th, 2009 at 4:07 am
I also liked the “House deals with everyday stuff” subplot, hope they infuse it with more creativity and make it a trend in the show
January 20th, 2009 at 4:14 am
(but the patient worse a respirator) in paragraph two should probably be “wears”
Why didn’t they put the patient in a chemically induced coma like they did the last time they put a patient on opioid blockers? Other than to torture the guy for dramatic reasons, of course.
January 20th, 2009 at 4:26 am
I admit, the House breaking his pipes subplot was entertaining, but not as entertaining as I’d expect from an epi of House.
Overall, I didn’t like the episode one bit. It was just… boring. The idea of it being that easy to find out who is on the medication and who isn’t makes me think that this study is being run very, very badly. And why is a suicidal patient not being supervised? In what world can you just discharge him without sending him to psychiatric care first? That’s just ludicrous.
January 20th, 2009 at 4:38 am
I agree with you on this one, it was really mediocre. I do hope the next episode is better.
January 20th, 2009 at 4:46 am
What I couldn’t figure out is why a guy who is in pain, with a cupboard full of narcotics wouldn’t try to kill himself with an overdose. In fact he’d have to work fairly hard to not overdose. Why go with the complicated carbon-monoxide route which leaves you brain damaged (but alive) if you’re interrupted, like he was. Most probably becuase it didn’t work for the plot.
This was definitely the most boring epi for a while, maybe ever.
January 20th, 2009 at 5:08 am
We were especially amused by the gigantic yellow duck here; my father gave us, I swear, the same model of giant duck when I had my first child. And, frankly, Cuddy’s place looked pretty good for a single working parent with a first baby (and what sort of baby is that, anyway? Did it cry even once?), and I loved Wilson’s take on the whole matter.
It did strike me that it might have been a good idea for the wife to drag suicidal husband out of the garage before attempting to resuscitate him.
January 20th, 2009 at 5:31 am
@Apsalar
“I also didn’t like how the wife insisted it was time to take her husband home to die, since they had been in the hospital for a whole 4 days. The man’s apparently been in agonizing pain for 3 years, and here you’ve got a doctor who is committed to figuring it out, and you want to give up after 4 days? Come on.”
It was the suicide attempts that changed her mind.
January 20th, 2009 at 5:36 am
The whole episode was so and so – no major ups or downs. The diagnosis actually made a bit of sense to me: Epilepsy located outside of the normal EEG pattern was not that far out. I do not understand how the guy never noticed he was seizing thought: That was what puzzled me the most not House’s explanations which made little sense (rewiring?) mostly because let’s face it neither Hugh Laurie nor Brian Singer are doctors. I do hope we see some of the “sex me up” House/Cuddy action soon thought – are those guys ever getting some? Fingers crossed for Cuddy – she is so hot and she seems to have survived 3 years without sex.
January 20th, 2009 at 5:39 am
I don’t get you guys. It was an awesome episode. Who cares if the solution of the case was weird or not? We’re not doctors. Every TV series is a bit unrealistic, but not every series has such great writing and performances. Season 5 gets better and better. Oh, and we should see Hugh Laurie naked more often! :))
January 20th, 2009 at 5:49 am
Yes it’s a work of fiction, but it makes it harder for thinking people to suspend disbelief if they don’t cross the T’s and dot the I’s.
I don’t really want to see Hugh naked, probably because I’ve seen him naked from 10 years ago and he’s a bit flabby. Also because he’s 50. Also because I’m a guy. But what I do find amusing is they make it look like he’s masturbating in the bath in the opening sequence after the title credits. It’s the sly jokes that are the best.
January 20th, 2009 at 6:08 am
I’d be happier with the show if at least some technical aspects took precedent over dramatic contrivance. It’d be satisfying if they chose to write within a more realistic parameter of reality.
“Oh, she must be on the placebo then.”
I suppose in future episodes we’ll see Foreman try to switch Thirteen out of the control group? Further breaking the integrity of the “double blind” trial.
January 20th, 2009 at 7:06 am
For the first time, and I can’t blive i’m saying this, the show was way too Mediocre. I’m a huge fan of “House”, and I’ve seen every episode that has ever been aired but none of them ever gave me the “I don’t belive i’m watching this” effect.
The Medical mystery wasn’t all that interesting being that it was about a guy who has the same symptoms as House. The soap was BORING ! goodness me….
And i do miss the House moments. Could only get a grin when the Lawyer asked “who’s Dr House ?” and he pointed at Foreman. I knew he’d refer to season 2’s final episode of him getting shot.
It makes me think that one of the script writers has been dropped or something. I do hope proceeding episodes would be less depressing cause I look forward to every episode of House
January 20th, 2009 at 7:24 am
“Oh, she must be on the placebo then.”
This, for me, was the most bizarre thing in this episode. I mean isn’t the whole point of a double blind test to make sure this exact thing doesn’t happen?
also, wendus92: If you don’t care about the medical stuff, then why are you reading a site called “House Medical Reviews”?
January 20th, 2009 at 8:02 am
The clincial trial plot is killing me. I’ve worked in clinical trials for 10 years.
Thirteen being in the trial in the first place – site staff/people in the reporting line of site staff often can’t be in the trial due to potential conflict.
An investigator dating a subject? I’ll admit I don’t recall that specifically being mentioned as prohibited in any of my training. But they’re talking about it in public places, with other staff around. Is someone going to point it out to them? Report them to the sponsor, or the IRB or anything?
I was really hoping for them to show some House-like coercive behavior out of Foreman, like talking Thirteen into not reporting adverse events in her diary so she can stay in the trial. But now, with the nurse’s offhand comment about the stink of the drug, and making Foreman think she’s on placebo, maybe he’ll try to convince her to withdraw?
And how about this: Thirteen is in fact in the drug arm but either 1) was accidentally dosed with the placebo that day, maybe because of the moving everyone’s appointments around, she got investigational product intended for another subject or 2) it turns out that Foreman lacks a gene involved in the receptors for smelling that particular odor, so he wasn’t able to smell it?
January 20th, 2009 at 8:14 am
Further commentary directed at wendus: Some of the people who post here actually are doctors. Scott, who writes the reviews, is a doctor.
Regarding the episode…if they want to add something to make the episodes interesting, it wouldn’t necessarily have to be something new. CLINIC PATIENTS were almost always interesting (or amusing, which is just as good). We don’t need to meet House’s plumber.
January 20th, 2009 at 8:46 am
@Scott,
Yep.. I actually saw it as him hoping (I guess) Foreman got shot this time.
Overall, I do agree the episode was mediocre at best… Especially considering it’s the first after the Xmas break.
January 20th, 2009 at 8:49 am
I had to miss this week’s episode to attend a meeting. Sounds like I didn’t miss too much. Here’s hoping next week’s episode redeems the show! :^)
January 20th, 2009 at 9:02 am
The stiff plastic baby killed this episode for me. I can’t believe they didn’t use a real baby or edit that out. Awful.
I love Lori Petty (A League of Their Own) who plays the Huntington’s patient who came back for the trial. It is fun to see her here. The patient’s wife was played by the woman who played Sarah, Matt’s wife, on 7th Heaven I think–Sarah Danielle Madison.
Wilson is almost missing and either I blinked or Chase wasn’t there. Cameron is running the ER. Maybe that gives her enough executive experience to take over a few of Cuddy’s responsibilities.
January 20th, 2009 at 9:07 am
Somebody mentioned “House does everyday stuff” as something that might be interesting. Could be.
“House’s Day Out”
I, for one, can’t picture House in line at the DMV, or pushing a cart around a Safeway looking for the condiments aisle.
Maybe he’d get his epiphany by looking a at a can of Zoodles?
January 20th, 2009 at 9:17 am
Official Comment
Kate:
Chase performed the spinal block, and appeared on screen for maybe 30 seconds.
January 20th, 2009 at 9:48 am
WOW..
I just have to ask if anyone knows about this because I went through something similar (and probably much worse) as the chronic patient did.
First off, it was the most traumatic experience in my life. Anyone who has been on pain management knows how painful it is to abruptly stop taking the meds. If anyone has taken buprenorphine too early, (before withdrawal symptoms occur) they know that it’s even worse than stopping cold turkey. Well, naloxone precipitated withdrawal is by far THE WORST. It’s indescribable to someone who hasn’t experienced it.
I went through it for an hour and I’d rather die than go through it for just 5 minutes again. It was like out of a horror movie… I went absolutely psychotic, felt like everything was just sucking out of me, dripping sweat, projectile vomiting, screaming at the top of my lungs for god to save me, hyperventilating, pulling the iv out and flinging it across the room. It’s hard to describe but I was 100% sure I was dying.
Anyway sorry for this long rambling post… it just really hit a nerve when i saw the scene in tonight’s episode. I almost couldn’t watch the part when they injected him with naloxone… but then, i knew they couldn’t possibly show what it’s really like.
So please tell me. can you die from antagonist precipitaed withdrawal? I know naloxone is given to people who have overdosed and stopped breathing but I was fully conscious and my pulse was actually high. Under what circumstance are people supposed to be injected with naloxone when they are conscious?
January 20th, 2009 at 9:58 am
Scott, what are your top 5 episodes of House, all-time?
January 20th, 2009 at 10:13 am
Zypchick: I hope the Foreman/Thirteen drug trial dilemma is resolved so cleanly.
Kate: I have a feeling Lori Petty will have a centric episode this season. Perhaps a complication with her huntington’s and drug trial participation.
Cuddy’s baby doll was plain to see, they should have kept it in the crib out of sight.
Unlike some of you, I thought Doctor House had some good bits this episode. I enjoyed the sideplot of him trying to stick it to the home warranty provider, only to find out he was responsible for the pipe to begin with.
January 20th, 2009 at 10:18 am
Can someone explain to me the part about the placebo and the “double blind experiment” thing.
I have no idea what Forman ar the nurses did back there…
January 20th, 2009 at 10:29 am
Oh man, I actually found this episode extremely depressing.
As a child of someone with depression who has tried to commit suicide, I can tell you I know EXACTLY how that little boy felt. I have watched my father degrade from proud and funny to downtrodden and sarcastic. The drugs help him but I know that if he really wanted to he would take his life (the worst is when he’s late home from work. I do my best not to have a panic attack). I don’t think I could do what the son did, and help him, but I have felt that same “he’s not dad anymore” feeling. I disliked this episode also, but for different reasons.
The Huntington’s trial story arc makes me want to put my head through a brick wall.
January 20th, 2009 at 10:54 am
As a scientist, I’d have to give the clinical trial protocol errors the biggest red “major error” caduceus you have. There are reasons those protocols exist. As smart as Foreman is supposed to be, you’d think he’d be aware of them.
January 20th, 2009 at 12:04 pm
I love the show House so much. They use real diseases and not made up stuff. I can’t stand the childish pranks of Dr House. I wouldn’t want to be one of his friends, even though he can show some very tender moments.
If I was very ill and needed a doctor, Dr House character would be the one I choose. I know that Dr. House would be the best doctor for the job but for a friend he scares me haaaaaaaaaaaa. I think Dr House character is what makes the show so good.
Clora May
January 20th, 2009 at 12:16 pm
Coming freshly from neuroanatomy course, as somebody, mentioned above, genitals lay in fact deepest in SI (primary somatosensory cortex) in areas near bottom of longitudinal fissure (between brain hemispheres). Interestingly enough intra-abdominal areas are on the other end of SI map, close to sulcus lateralis (side of the brain, superficially).
So this time writers are not far from actually making sense here. However, how the regions would actually “light up” on EEG is outside of my area of studies.
January 20th, 2009 at 12:17 pm
… and there was way to much water in the ceiling to be held up by the dry wall and not leaking more.
There had to be a few gallons up there!!
I thought that was going to be the “Aha” moment but …
January 20th, 2009 at 12:28 pm
I also thought it was very mediocre. I did laugh at the “Foreteen” by House. Someone’s been reading forums!
But, the only thing that I was halfway interested in was the subplot about the pipes. And I also find it sad that House is starting to get relegated to a subplot.
I really don’t care much for Cuddy and her baby. I really don’t like Foreteen. The POTW and family bored me.
I could hardly pay attention.
Here’s hoping next week’s episode is better!
Kat
January 20th, 2009 at 12:55 pm
I laughed out loud when the kid was screaming and House hit out with the whole “deathwish daddy” line, then when he pulled the kid up and told him to fake it better. I’m still laughing thinking about it.
January 20th, 2009 at 12:59 pm
@Tom Canada – Somehow, I’m seeing an episode where he off-hand diagnoses someone in the supermarket (”Ma’am, if you’d please stop sneezing on the canteloupes before the rest of us can squeeze your melons…” “I can’t help it sir. I’ve been sneezing uncontrollably since yesterday” “Well, no wonder! You’re applying your eye makeup like Tammy Faye Bakker and the inflammation of your nostrils indicates that you have Bermingham’s Syndrome, which reacts badly to kohl-based mascaras. Now leave me to my melons, woman!”) followed by him getting pinned down by person after person giving him their symptoms and asking him to heal them (If they could license the music, the bit from Jesus Christ Superstar with the lepers would make wonderful background music). For the soap opera sting, we get House getting to the office, hoping to get a rest, and he’s served with a summons from someone suing him because a suggestion he made proved harmful.
^_^ For bonus points, we can have a House vs. crotchety old lady as they try to wield their respective infirmities against each other in a fierce battle of dominance trying to get to the checkout line first, uncaring of who they have to knock out of their way, claiming as excuse the cane and walker respectively.
January 20th, 2009 at 1:46 pm
I just finished taking a research methods class and know my professor would flip out at the way the so-called double-blind experiment is going. Seriously, this should be shown in class as a case study of what should NEVER happen.
Did anyone notice near the beginning of the episode, when Cameron is trying to convince House to take the case, that Thirteen looked dismissive and annoyed at Cameron? What was that attitude about? I mean, Taub wasn’t thrilled about the case either, but he didn’t look to be so annoyed at Cameron personally.
Scott, thanks for posting the reviews so quickly. I love being able to check out this site the day after a new episode airs.
January 20th, 2009 at 1:51 pm
Foreteen! I bet they read that on the previous episode review comments =p
January 20th, 2009 at 2:00 pm
I think the episode was good. The day of week was wrong. Maybe the date was wrong too. On Thursday 12/16/08 you all would see it as a good episode.
January 20th, 2009 at 2:10 pm
To Dork: I don’t find Hugh flabby at all :) He’s got an awesome body..
http://www.squarehippies.com/images/actors/hugh_laurie/hugh_laurie4.jpg
January 20th, 2009 at 2:15 pm
I understand why its bad for the researcher to know who is in what group. I know why there are issues with people coming into the trial late, personal interactions with test subjects, subjects switching trials.
Foreman hadn’t know what group thirteen was in until the nurse told him. The nurse figured it out on her own. Presumably the placebo was just saline.
I guess I didn’t see anything wrong done in running the trial (this week) with the exception of the nurses off handed comment and I find it difficult to place a lot of blame on her.
One more comment, Scott, you should probably bump the copyright.
January 20th, 2009 at 2:39 pm
Did anyone noticed that House has a yellow rubber duck? Nice reference to Bertie Wooster! :-D
January 20th, 2009 at 2:42 pm
I’d find it amusing if the placebo turned out to be the smelly one, Foreman switches her meds, and she dies or something. It’s not like anyone should actually know what each one smells like anyway.
January 20th, 2009 at 2:46 pm
I am in chronic pain, so maybe I am biased, but I thought is was an OK episode. Loved the Wilson stuffed toy–funny, and the line about world domination.
January 20th, 2009 at 2:49 pm
Also, the study was not even close to double-blind. He had a stake in it (having a friend with it) and when they got involved, it is the opposite of double blind. And I thought only one or two people knew who was on the placebo or not (and why wouldn’t they try to disguise it a lot better?).
January 20th, 2009 at 3:43 pm
Thanks, Scott. I always come here for the science!
January 20th, 2009 at 3:47 pm
Damn, Hughs got a hot body!
January 20th, 2009 at 3:50 pm
Very disappointed with the first episode in the new season. Considering that it was pushed back 2 weeks from the original airing, the wait was not at all worth. I agree about the lack of “Houseisms”. Also I think since season 5, the soap content (as compared to the actual case at hand for the team) has not only increased but has become boring . Let’s hope it changes in the coming episodes. I really preferred the old team with house, foreman, cameron and chase. But maybe that’s because I am usually averse to change
January 20th, 2009 at 4:35 pm
I cannot disagree with the general consensus more. I think this was a great episode – at least the non-medical aspects which I can attest to. If House was not witty or funny, the episode explained it was because of an increase in his pain. I think he delivered great lines (’Will you let me die?’, ‘No.’) and expressed himself particularly well nonverbally.
I feel that this episode was written as a launching on point for a new audience (new time, new day) and was somewhat simplified, but not to its detriment. Each character was given moments natural to their development, great new plot lines were developed or thickened, the episode has great symmetry, pacing, and a sense of dread, and the writers and cinematographers again showed a willingness to experiment and expand.
Please Scott! I implore you, as a huge fan of your site, to watch the episode again and reassess.
January 20th, 2009 at 4:59 pm
Agree, whole episode a bit sluggish. And not only was the fake baby conspicuous, even the kid struck me as a sub-prime actor. I fear that along with demotion to 8 p.m., they’ve cut the casting budget. Could it be repurcussions from the writers’ strike? Which HL supported.
I have no medical knowledge, but in the best shows the mystery is logical enough, and well-explained, to feel I’ve learned something real. This seemed all muddled.
January 20th, 2009 at 5:43 pm
I liked it, and though it was a great episode.
January 20th, 2009 at 6:17 pm
All the comments about horrible double-blind procedure are dead on. It would be fine for Foreman to organize the trial, maybe even single out someone to get the real drug, but he just can’t be otherwise involved in monitoring the patients.
And of course, if the nurse can tell the difference between the placebo and the real thing, somebody really screwed up.
January 20th, 2009 at 6:31 pm
A “pain profile” to rule out psychosomatic illness, huh? I suppose that works with the established pattern of the show, i.e. propose a diagnosis and then run a test to rule it out, but it is extremely poor clinical practice. And demonstrates a very boneheaded view of mind-body interaction in medicine. I did like when House had to clue them into the possibility that the pain contributed to the depression more than the other way around.
eXK said:
“So please tell me. can you die from antagonist precipitaed withdrawal? I know naloxone is given to people who have overdosed and stopped breathing but I was fully conscious and my pulse was actually high. Under what circumstance are people supposed to be injected with naloxone when they are conscious?”
The rubric is that withdrawal from opioids is not life-threatening (although it is excruciatingly uncomfortable) except a rare instance in which the tachycardia or hypertension associated with acute withdrawal were to interact with a preexisting medical condition. However, withdrawal from either alcohol or benzodiazepines (or barbiturates) can cause seizures and delirium tremens which carries a real risk of death. This could be precipitated by the antagonist flumazenil in a vulnerable patient. It used to be that they would give flumazenil sometimes to patients with altered mental status who were suspected to have OD’d on benzodiazepines but they basically have stopped doing that because of the risk of seizures and the fact that you can just use supportive care, including intubation if necessary, to deal with the respiratory depression caused by benzo intoxication.
When would you give naloxone to someone who was conscious? Can’t think of a situation.
January 20th, 2009 at 6:56 pm
I thought this was a good ep if not pulled together well. It served to remind some of House’s coworkers how much pain he really is in and it was nice to see Cameron doing what she does best.
Thirteen/Foreman is potentially interesting but I will reserve judgment for later.
January 20th, 2009 at 6:59 pm
Jon:
I have to say I’ve been disappointed since about half way through the third season.
Uh-oh. That has “shark” written all over it…
January 20th, 2009 at 7:13 pm
Dork:
House wasn’t masterbating in the bath, he was grunting of pain, and massaging his leg… introducing the pain as a recurring theme in the episode.
January 20th, 2009 at 8:20 pm
As soon as I started watching this episode, I realized it was a “pain” episode. Most of the time they ignore House’s leg, except for a few remarks and the constant pill popping, but sometimes we’re shown what pain he’s in. I think that accounts for the lack of “Housisms” today.
Also, when did Thirteen start feeling pain in the first place? Did I completely miss this? She says “I’m feeling better,” but I thought Huntington’s didn’t affect you until the onset, which she hasn’t reached yet…
As for the episode as a whole, it was so so… I did enjoy some parts, but having watched some excellent episodes from earlier seasons in the USA marathon today… wasn’t as good…
January 20th, 2009 at 8:22 pm
Edvinas:
I’m far from an expert but I did read such things in the dim past. : )
When doing an experiment such as a drug trial, it’s standard scientific and medical procedure to have at least two groups of people: Group A , the group that you are giving the drug, or treatment to, and Group B, the group that you are NOT giving the drug to. (Group B is known as the “Control Group.”) There are lots of good reasons why one wants a control group. One of them is because of the Placebo Effect. A placebo is that thing which one gives to a patient that has no effect. (Think of goiving someone a sugar pill instead of the real drug.) But since the brain THINKS that it’s getting a real drug, the patient will feel better. Also, because psychological things will effect the patient, say, the way the tester greets the patient, this too could have an affect other than the drug being tested.
Because of this, experiments such as clinical drug trials, evolved the “double blind trial.” The method is simple, Neither the patient, NOR THE TESTER WHO IS GIVING THE PATIENT THE DRUG knows if it is the drug or the placebo that is being given. (This also prevents a corrupt tester such as Foreman from switching the meds and thus corrupting the experiment.)
Though I can understand why the show writers didn’t bother explaining what a double blind trial is, I was surprised that the show’s writers didn’t seem to know what a double blind trial is. I wasn’t aware that this standard medical and scientific procedure was an arcane secret.
Jean
January 20th, 2009 at 8:33 pm
hmm maybe i should ask like this:
To All Doctors:
would you give naloxone via IV push to any patient for any reason if that patient was on a high dose of opiates (and had been taking them for years) and if so under what circumstance?
January 20th, 2009 at 8:40 pm
What was the reason House needed a lawyer’s name?
January 20th, 2009 at 8:55 pm
kurious: He wanted the name of a good lawyer so he could use it in a threatening e-mail to his insurance company. You know, like the lawyer whose name he used told us when he came to House’s office and threatened to sue House.
January 20th, 2009 at 9:13 pm
zypchick, regarding the clinical trial you said:
And how about this: Thirteen is in fact in the drug arm but either 1) was accidentally dosed with the placebo that day, maybe because of the moving everyone’s appointments around, she got investigational product intended for another subject or 2) it turns out that Foreman lacks a gene involved in the receptors for smelling that particular odor, so he wasn’t able to smell it?
that’s EXACTLY what popped into my mind too! makes me think of asparagus pee! :-D
January 20th, 2009 at 9:39 pm
It was nice to see Anthony Montgomery from Star Trek as the guy that inspected Cuddy’s house. My favorite part of the episode.
January 20th, 2009 at 9:48 pm
Wow! tuff audience. as one who has suffered with chronic pain AND an allergy to NSAIDs, it really wasn’t that boring to me. I thought the guest actor did a great job of portraying that hopelessness and despair that drains the color from every day when you are forced to live like that and the medicos have nothing more to offer than narcotics (bleck!). the director (was that Katie Jacobs again?) did a great job of unfolding that story in a monochromatic and emotionally deadening way — as affirmed by the reactions of people on this board. there are more people suffering in this way than you imagine. for them, it was liberating to see someone go to bat for their cause, rather than shuffle them off to yet another psych eval.
and taub’s anger reaction was valid writing, too.
don’t get me wrong. not my favorite episode, but sometimes art is like that. not every story is beautiful, but that doesn’t make it unimportant.
it was an interesting problem for House to tackle, too.
on the other hand, moving Cameron into Cuddy’s position (next week’s preview) is the single most improbable idea they could have come up with, in my view.
January 20th, 2009 at 9:50 pm
“Oh, she must be on the placebo then.”
This isn’t such a big deal for the plot. For one, the show established how the nurse found out which bag was the drug (smell). Placebo needs to be saline and can’t have smelly compounds. For two, it seems believable that a less-than-interested individual might disclose that information. It happens. Not everyone adheres to rules strictly. They should, but I’ll accept it if it happens.
January 20th, 2009 at 10:22 pm
I want to know why Cameron gets such interesting cases in the ER so often. I’d think the writers would put more emphasis on House’s reputation and people would seek him out as a specialist in unsolved cases.
Flexeril would have helped this guy
January 20th, 2009 at 11:16 pm
Does the plumber scratching his balls win the “most bizarre inspiration for a House epiphany” award?
January 21st, 2009 at 12:43 am
Only if the presenters have never met a plumber. (Seriously, I’m pretty sure all plumbers scratch their balls.)
January 21st, 2009 at 2:06 am
eXK said: “would you give naloxone via IV push to any patient for any reason if that patient was on a high dose of opiates (and had been taking them for years) and if so under what circumstance?” The answer for this is NO. How about talking for therapy about drug addiction (morphine addiction is a good one)? You use replacement drugs (can’t remember the name of the replacement drug for morphine) the point of the replacement drug is to AVOID withdrawl symptoms (which aside from painfull can have other pretty nasty side effects) Frying your system with Naloxon when you are fully concious under no sedation whatsoever after beeing on 10 different pain medications is a terrible idea. Why didn’t they use rapid detox for example (they used it before in the episode with the girl that was a guy)? Anyway the answer is NO NEVER
January 21st, 2009 at 2:12 am
The replacement drug is called Methadone you can read about it here http://en.wikipedia.org/wiki/Methadone
January 21st, 2009 at 5:46 am
Am I the only one who has been missing House’s whiteboard this season?
I’m not a doctor so I often forget patient’s symptoms or the suggested diagnosises go right over my head. But House’s whiteboard helped me remember it all and make sense out of the show.
January 21st, 2009 at 6:35 am
eXK said: “would you give naloxone via IV push to any patient for any reason if that patient was on a high dose of opiates (and had been taking them for years) and if so under what circumstance?”
Basically I agree with D-r Bulgaria, although for acute respiratory depression (NOT the patient in this episode) you might give naloxone as a rescue even if the patient was on chronic opioid pain meds, because they will wake up in acute opioid withdrawal but at least they will be breathing. (Be prepared to deal with an agitated patient who has been jolted into a highly painful state, however.)
I should amend my earlier statement about naloxone to a conscious patient; there are some instances but they don’t involve IV administration of the drug. Both naloxone and naltrexone, another opioid antagonist, have been used to decrease self-injurious behavior, especially in developmentally delayed (such as MR or autustic or other PDD patients) although sometimes in normally developed but borderline personality disorder patients. The thinking is that you are blocking the endogenous opioid endorphin release that can accompany self-injury, thereby making it less reinforcing and hopefully leading to extinction of the behavior. This is an interesting idea but not super effective in practice. To my knowledge all trials of opioid antagonists used this way are small and equivocal. You can also use naltrexone for motivated patients with substance use disorders. You might use it in an opioid user after detox who wants to stay clean. It does not work as effecitvely (i.e. to prevent relapse to opioid abuse) as opioid replacement with either methadone or buprenorphine. Interestingly, there have been some promising results of treating alcohol abuse with naltrexone in motivated recovering drinkers, which seems to decrease craving and perhaps to decrease how enjoyable drinking is. Unlike the old disulfiram, aka Antabuse, it is not harmful to drink while on naltrexone, but it may be less fun.
One other use for naloxone is in combination with the opioid replacement buprenorphine in a formulation called Suboxone. The way it works is that the buprenorphine is the active medicine and pill is coated in naloxone which dissolves and is never active in the body if the medicine is taken orally. If, however, you grind up Suboxone and try to inject it, the naloxone is active and you are not able to get high (and you probably will go into withdrawal). This helps prevents its diversion to IV use (although it is still diverted to people to whom it hasn’t been prescribed because Suboxone has street value for people who are trying to self-detox or who are just looking to avoid getting dope sick).
January 21st, 2009 at 6:36 am
Maybe this is too far fetched, but I’ll try anyway.
I think the whole point of the double-blind trial scene was to show that they have screwed the procedure.
One can only argue that the drug supplier should have supplied the placebo that smells the same, but apart from that it is totally plausible.
And, frankly, I don’t know about the States, but in my country worse pharmaceutical companies’ screw-ups happened (such as switching an asthma drug to an anesthetic drug, resulting in several deaths).
January 21st, 2009 at 7:22 am
On the other hand, what shocked my the most, was the poor guy’s family reaction. “Please, let my daddy die, please let my husband die…” WTF?! That is one seriously damaged family.
January 21st, 2009 at 7:24 am
I’m not really much of an expert in this, but wouldn’t Foreman know that the real medicine smells bad without the nurse telling him that? I mean a nurse knows more of the trial than does the doctor who’s actually carrying out the trial?
January 21st, 2009 at 8:31 am
As far as Cuddy’s job goes, I think we can all agree that she just meant for Cameron to act as a sort of supervisor to House in the same way as Foreman who failed that.
January 21st, 2009 at 8:55 am
“I think it’s pretty clear that neither Foreman, the nurses, nor the writers have any idea what a double blind experiment actually entails.”
So that part’s pretty realistic then.
January 21st, 2009 at 11:01 am
There’s a typo in the MAJOR COMPLAINTS, second ‘paragraph’ – ‘rather thaN’ instead of ‘rather thaT’
January 21st, 2009 at 11:24 am
A lot of people don’t seem to get what happened with the nurse. She doesn’t -know- who’s on the placebo and who’s on the drugs, she’s just found that one bag of meds smells, the other does not. She simply made an offhand and unprofessional comment about that fact to foreman.
Dissapointed that so many people have got that wrong.
Unless I’m wrong and the people attacking it saying that in a proper trial, the placebo would be scented the same? Would that even be feasible?
(Note: I agree that allowing foreman’s colleague in the trial is laughable and requires some suspsension of reality, but that aside.)
January 21st, 2009 at 11:34 am
Scott, I love your reviews, but I disagree about the soap-opera being barely adequate. I’m really enjoying the Foreman/Thirteen storyline, especially the new development that Thirteen is on the placebo. I know that violates the precepts of a double blind study, and that actually does take away from my immersion. That being said, this puts Foreman in a position to violate his ethics and either continue his relationship with Thirteen, knowing that she’s probably going to get much worse, OR change her bag to the real stuff and thereby violate the validity of a potentially life-saving study.
January 21st, 2009 at 2:31 pm
@Eric: of course this puts Foreman in an ethical dilemma, but that dilemma is universal in placebo-controlled clinical trials. One could argue that the placebo group doesn’t get the best possible treatment.
January 21st, 2009 at 3:18 pm
I got a House line for yah:
Scent of a man: I realize you haven’t experienced it sober.
January 21st, 2009 at 3:21 pm
As for me, i believe that nurse would be more sensitive to smells than foreman, since almost every woman I know has about ten times pickier nose than any man I ever met. But even so I do not buy that double blind test would be screwed up that badly.
January 21st, 2009 at 4:54 pm
@Jonathan In the *real* world, the trial would not be new drug vs placebo, it would be real drug vs best currently available treatment, for precisely this reason. You can’t ethically deny someone the best currently available treatment just in order to discover whether or not you have a new drug which works better. You only test a drug against placebo if you are trying to discover whether there is any effect at all in the new drug.
January 21st, 2009 at 7:14 pm
Actually, assuming I’ve spent enough time on sciencebasedmedicine.org and Respectful Insolence to have a clue what I’m talking about, I believe if there was an established treatment, the trial would probably be new drug + established drug/treatment vs just established drug/treatment due to the fact that the experimental drug could offer no benefit and it would therefore be unethical to treat only with the unproven drug. If the new drug + standard of care treatment was shown to be more effective than the standard of care treatment alone, then trials of just the new drug vs standard of care could be done.
However I think we’ve already established that the writers don’t know a double blinded RCT from a hole in the ground, and couldn’t tell the difference between a phase 0,1,2,3, or 4 trial if their lives depended on it. Flying Spaghetti Monster only knows which type of trial this one is supposed to be.
January 21st, 2009 at 7:23 pm
Dear Fish ~~ Umm, yeah. Most of the time the nurse knows more about the dailies than the attending. There has been some great press about this situation when the nursing salaries are up for review.
January 21st, 2009 at 7:26 pm
I enjoyed the episode but this is the first I saw after watching four and a half seasons in two months. Finally, I’m seeing House in HD!
Amazing that they used a doll after making the baby such an important part of Cuddy’s life. I fear House is turning leaning too far in the soap-opera direction. It looks like the baby and another long-term boy/girl relationship (13/14) are in our future. I certainly hope House and Cuddy do not go any farther. House and Wilson are traditionally alone and the relationship between the two of them wouldn’t work as well if they weren’t IMO.
I enjoyed watching House being doused with water. It reminded me of the mosquito/explosion scene, which I found entertaining because of the “House dealing with normal everyday things, unsuccessfully” attitude. I was, however, very disappointed that the pipe subplot didn’t lead somewhere more entertaining.
I know little about the medical industry but the incompetence of the hospital staff dealing with the suicidal patient seems like a bigger screw-up than the double-blind experiment to me.
I disagree with the opinions that season 5 has been a poor season.
The camera perspectives and tricks add a lot to the show for me. The various angles of House’s head are great. Season 5 has been no exception. The cold opens in Joy (coffee, clocks, making the kitchen look larger) and Last Resort (sweeping through the waiting room before the Hostage-taker is revealed) both blew me away.
Seeing Wilson’s humor returning has been good. House and Cuddy getting a bit closer has been interesting. And how about the PI Lucas? Am I the only one who loved watching House interact with him (I hope he is brought back). House dealing with a character he has no control over, can not intimidate, and is dependent on was great- the two personalities next to each other cracked me up.
The specifics of the medicine don’t influence my feelings about the season as much, so perhaps that’s why I don’t agree. I still find that I’m learning new and interesting things in most episodes (the fMRI/lie-detector really interested me).
Very interesting to read all the responses from those of you who are in the medical community. I wish medical-related responses were flagged with a red-cross plus or something so I can skip things like what I’m writing when I’m curious about the medicine! :)
January 21st, 2009 at 7:30 pm
I personally found the episode really hard to watch, like someone else who posted before me, i have been living with an undiagnosed severe chronic pain problem for 3.5yrs (4yrs come end of march)…i’m 30y/o and its disabled me, it started out of no where, i’ve been to over 16docs, out to the mayo clinic, countless tests, countless meds, and have ended up to point where i’m on much stronger narcotics (morphine long release and hydromorphone quick acting) which just dulls it and makes me more “functional” (basically enough so i can work 3days a wk, nothing more). Its horrible to live this way. horrible. and depressing as all get out. So for me, watching it, I was kinda hoping the answer would be something i could look up and see if it fit, but i dont have balls. haha. Oh well. Anyway, i found it to be good in the fact that chronic pain is an invisible illness and sooooooooooooooooooooooooo many people believe those with it are either lying/faking or its a psychological problem. This episode shows it on a different level…i’m kinda bummed b/c thats seemed to have gone un-noticed/acknowledged in this bunch. I hope you re watch it from that perspective some day.
To those IN pain, i feel for ya and hope you feel better too.
January 21st, 2009 at 7:45 pm
Well, I did like this one. The paralellism between the patient and House was well carried out, even there’s one sequence where the patient on his bed segues to House waking up in his (and discovering the whole plumbing mess).
Did House find something about himself, as Cameron intended? Probably… we’re only halfway through the season.
January 21st, 2009 at 8:05 pm
re: “Also, when did Thirteen start feeling pain in the first place? Did I completely miss this? She says “I’m feeling better,” but I thought Huntington’s didn’t affect you until the onset, which she hasn’t reached yet…”
From my wife’s experience and what I know from fellow caregivers, HD doesn’t cause physical pain. (Directly that is; bumping into things, falling, choking, etc. can certainly be painful!) We should probably assume that Thirteen was referring to her mood…
January 21st, 2009 at 8:58 pm
I have a rule about House that determines the basic quality of the episode, which is this: if I have to come here a couple of days later to remember what the patient’s name was, it wasn’t that good. Well, here I am, so that should explain what I thought of it.
This episode was so dull that by ten minutes into 24, I didn’t care what I had seen.
January 21st, 2009 at 11:18 pm
As far as the Suboxone combination thing….
Buprenorphine has much higher receptor affinity than Naloxone does, so if an addict were to crush up and inject it the Naloxone would actually have little to no effect. Now, one would question the value of using what is effectively a detox med as a method to get high, but addicts do crazy things sometimes. Just a little knowledge…
January 22nd, 2009 at 12:12 am
No one in Jersey actually says each letter when they say DYFS. We just pronounce it as “dai-fuss”. Even the employees pronounce it that way. The cursory check the guy did of Cuddy’s house was accurate, though. They never bother to really look into anything.
January 22nd, 2009 at 12:50 am
Oliver: Yes I know he wasn’t masturbating, but if you look at it again they’re obviously playing up to it, otherwise they wouldn’t have used that series of shots. Or maybe I have a pre-occupation with masturbation. I think it’s the former, they’re having a little laugh.
Am I entirely alone on this? So to speak.
January 22nd, 2009 at 7:22 am
BPK and DR Bulgaria, thanks for replying.
I was curious as I was the victim of sadistic paramedics… If you read my earlier post, I describe as best as I can what it felt like to be given naloxone while I was fully conscious. It wasn’t fun. Also, do either of you (or anyone else) know if it is possible to die from antagonist precipitated withdrawal? If so, I think I have a lawsuit.
By the way injecting suboxone will NOT get naloxone active in your system because buprehnorphine has a higher binding affinity than naloxone. I still don’t know why they do it. I guess to scare people into thinking what you said was true.
January 22nd, 2009 at 9:43 am
No comments about the Taub suicide “mystery”? I thought it was poorly handled. If a co-worked claims to have known somebody who had attempted suicide, would you dig at him to try to find out who, accuse him of disguising a story about himself, etc? It didn’t ring true.
January 22nd, 2009 at 10:58 am
What was the ending of that Taub subplot? I absolutely cannot make out what he says at the end to Kutner.
January 22nd, 2009 at 11:09 am
Scott, if you gave the med plot a D because it didn’t seem to follow what you know about neurolgy, and then people who do have a good grasp of the area write in to say that it actually made sense and there was a reason for saying deep in the brain and that it was difficult to see on the EEG, do you ever redo your grade? It seems a bit harsh if you just didn’t understand the medicine yourself. I also think that an episode dealing with uncontrolled chronic pain so severe the patient wants to die is not going to be one of the lighthearted eps–this is a possible future for House. I still laughed myself at the pipes subplot, scent of a man and Taub’s lines about the subcommittee. But it was a sad ep, not an overall funny one. Also, I think the breaches in double blind procedure on the show are meant to be just that. Foreman hid from his trial leader that he was invested in Thirteen personally, he hid from Thirteen that he had moved her schedule around and if he does something further now, he’ll hide that, too. The nurse was supposed to have a big mouth and be unprofessional, and I’m sorry, but in the real world, that happens. It shouldn’t but it does, so it’s fair game for drama.
I liked the episode very much. The worst part to swallow was the choice of Cameron for stand in, but in the show’s defense, it makes no sense whatever to bring in another new character. Hopefully, this will be handled somewhat believably, because it is a clunky plot choice.
January 22nd, 2009 at 1:49 pm
Question:
1) What is the significance of plasebo for Thirteens drug trial?
I don’t like how Wilson and Chase were almost nonexistant in this episode. There was no scene with House and Wilson or with Cameron and Chase. I also think that Cuddy shouldn’t have offered Cameron her job. The show’s not gonna be the same without House always going to Cuddy to check procedures.
I agree what someone said about the white-board. 5th season hasn’t really had the white-board much… It’s almost like they aren’t doing the diferentials as much either.
January 22nd, 2009 at 3:00 pm
Jumping in on the Naloxone thing, I am starting to do some initial research on this for personal reasons, and I saw the initial question from eXK about when Naloxone or any other opioid antagonist would be administered to a concious person:
My understanding is if you go to a detox clinic that uses methadone as a weaning agent without a referral from a doctor, they give you a dose of Naloxone or other antagonist to see if you actually -are- habituated, as an addict will go into withdrawl whereas a non-addict will not be effected. Once you start cold-turkeying, they administer an opiate with a higher binding affinity to get rid of the Naloxone and then get you started on your methadone weaning.
Please keep in mind this is not confirmed, just what i’ve heard.
BTW, excellent blog, I really enjoy reading the medical opinions of the medicine behind the show, i’ve been a fan of Huge Laurie since the “Blackadder” and ‘A Bit of Fry and Laurie’ days,and was amazed to see him take such a dramatic turn, but frankly now I can’t ever see anyone else as Dr. House. Who knows? I might just start posting here.
January 22nd, 2009 at 3:49 pm
Everyone is waiting for Cuddy and House to finally do something about their relation… Maybe House needs to give her some risotto. (Some will understand, some won’t).
I liked the episode… Was entertaining… Didn’t like the kid. I laugh when house finds out how the pipe broke, and also got a little surprised when i heard him using the Foreteen… ¿Do the writers read this medical reviews?… Don’t know if the idea came from here, but it was the first time i saw it… But what do you know? The internet is so big…
Love this site… I really do…
Heishiro.
January 22nd, 2009 at 3:55 pm
I chuckled mildly at the catalyst for House’s epiphany… I wonder if the plumber saw House smiling as he saw him scratch his nuts….
January 22nd, 2009 at 4:08 pm
The Taub subplot ended in Taub saying “No” it wasn’t him who tried to commit sucide and then “I’ll see you tomorrow” to Kutner before walking away. So we still dont know who it was he knew….
January 22nd, 2009 at 4:13 pm
What about the correlation between House’s big pain episode after he broke up with Stacy and the big pain after Cuddy got her baby, and therefore broke up with him? Anyone else see this?
Season 5 is a big disappointment. Almost no clinic nor whiteboard. What’s the point? Sigh.
January 22nd, 2009 at 6:12 pm
Jess, Taub’s denial wasn’t terribly convincing.
January 22nd, 2009 at 8:15 pm
SoonToBeDoc and eXK,
Thanks for the info about Suboxone. I totally believed what I’d been taught that the naloxone precipitated withdrawal, so thanks for setting me straight. I am a psychiatrist, fully trained in adult psychiatry but now doing a fellowship in child and adolescent psychiatry. I personally haven’t prescribed buprenorphine. You have to take a special class in order to be certified to prescribe it. I wish I could say there’s no need for opioid replacement therapy in children and adolescents but unfortunately there are some pockets of heavy heroin use in teenagers as young as 13-14 around here.
January 22nd, 2009 at 10:03 pm
Jess, Eric is right. It was Taub. Just like Kutner was the bully, Taub was the attempted suicide.
January 23rd, 2009 at 5:41 am
to BPK: I stand corrected about the use of Naloxon in the cases described by you. I find it hard to believe however what Rooster said that doctors actually use Naloxon as lie detector. The use of ANY drug that could cause such an excruciating pain is a serious ethical issue even if the target is a junkey. Unfortunately treatment for those guys is not easy in any of the cases.
to eXK: To die from withdrawal is possible however I seriously doubt you can do it in a hospital while the doctors are observing you (as was your case right?) I cannot say anything about the reasons you got tortured thought – medical decisions are subject to committees not message boards.
January 23rd, 2009 at 9:51 am
“a blockage in his superior mesenteric artery which has blocked blood flow to the intestines and damaged then.”
The last word should be “them”
January 23rd, 2009 at 11:17 am
Hi D-r Bulgaria, as I said I didn’t know if this was fact or not, just what i had heard.
It did make sense to me however, how else can you quickly distinguish a true junkie who wants to wean off the hard stuff from someone who just wants to score some free opiates? And from what i heard they stop the withdrawl right away once it’s clear the Naloxone dosed person is effected.
Heh, maybe I should just call a clinic and find out myself, there’s enough of them here in Vancouver.
January 23rd, 2009 at 12:52 pm
Peeps –
Long-time reader, first-time poster. This episode was, by House standards, very dull. Though, as one poster mentioned earlier, even bad episodes of House are better than most of what’s on television.
I immediately thought of this forum when House uttered his “Fourteen” line – I had to explain it to my wife, who thought a better nickname would have been “Seventeen.” If we see House use this line in a few weeks, we’ll know where their getting their inspiration.
The clinical trial/Fourteen subplot is indeed dragging the show to a grinding halt, mostly because it just seems so damn common, Harlequin romance-for-the-sake-of-romance, cliched.
Of course, this could just be a long con, with a massive twist at the end of it. They could be lulling us to sleep with a boring storyline to give us a slap-in-the-face, I-did-not-see-that-coming resolution later in the season.
God I hope so.
January 24th, 2009 at 3:36 am
Oh, damn it, we´ve dropped to “Not cancer” level again. This was another ep with laim explanation (but what explanation can you give for a patient with a no-sense-making constellation of symptoms???).
1. Cuddy´s baby doll cried, at least I heard it crying for a few short moments.
2. I can believe someone recognizing who´s getting placebo. I heard about study where placebo shots were a lot more painful than the real stuff. But telling someone else is sure unethical. The nurse should have kept her mouth shut.
3. I don´t think the doctor running a clinical trial necessarilly has to know the properties of the drug. The researcher who invented it surely would.
4. I guess Foreman is going to switch Thirteen´s and Janice´s meds.
5. Thirteen felt better mentally. As far as I can remember, she hasn´t developped significant symptoms yet.
6. Hope next ep is gonna be much better!
January 24th, 2009 at 9:40 am
Since this was a brain-related cause of pain, shouldn’t the spinal block have had no effect, not a partial one?
i thought he was lying so that he could be left alone to commit suicide