House — Episode 8 (Season 6): “Ignorance is Bliss”
A so-so mystery, but an interesting patient on this week’s episode of House.
James Sidas was a brilliant physics prodigy who quit the field twelve years ago and now works as a deliveryman. While he is delivering some books one day, he develops a hand tremor and some confusion. He is admitted to House’s team at Princeton-Plainsboro Hospital, with the presenting complaints of ataxia (loss of coordination), anemia, and a mild cough. A CT scan was negative, as was a screen for toxin screen. The team’s initial differential diagnosis consists of West Nile Virus, hyperbilirubinemia (high bilirubin levels in the blood), meningitis, sickle cell anemia, or TTP (thrombotic thrombocytopenic purpura). The last one seems the most likely so House has his team check a blood smear and AdamTS13 antibodies. The blood smear shows schistocytes (fragmented red blood cells), a sign of TTP, so they decide to begin treatment. Usually, plasmapheresis is treatment of choice, but James is allergic to one of the components of the procedure, so instead they perform a splenectomy — a removal of his spleen. The surgery goes well, but while Chase is examining him afterward, James begins to show symptoms of a stroke. He is rushed to the cath lab, where the clot in the brain is removed by a special catheter, “blood flow is restored,” and there is no permanent brain damage.
The fact that James suffered a stroke after his spleen was removed suggests that he did not have TTP. The differential now consists of CNS vasculitis (inflammation of the blood vessels in the brain), DIC (disseminated intravascular coagulation), acquired pancytopenia (low white cells, red cells, and platelets), or a toxin exposure. The team reasons that the basic toxin screen only tests for a few toxins, and they need to test for more. Chase and Taub are sent to search James’s apartment, while Thirteen and Foreman run an expanded toxicity screen. The apartment shows signs of mice (and Taub suggests James may have Leptospirosis), and a hidden bottle of booze.
The team now suspects that James has liver failure, probably due to alcohol abuse. When confronted, James admits to having a shot of vodka each day after work, but denies being an alcoholic. The team proceeds with a liver biopsy, which is normal. The liver function tests show a slightly elevated albumin, but are otherwise normal. Thirteen now deduces that James has renal (kidney) failure, not liver failure. The reasons for the kidney failure could be rhabdomyolysis (muscle damage), multiple myeloma (cancer of the blood forming cells), polycystic kidney disease, or Goodpasture’s Syndrome (an autoimmune disease that affects the kidneys and lungs). Goodpasture’s seems the most likely, so James is started on unnamed “immunosuppresant drugs” and dialysis. After a Eureka! moment in a conversation with Wilson, House realizes that James has been abusing dextromethorphan (DXM, also known as the DM in “Robitussin DM”). He has been taking it to suppress his intelligence, and taking the alcohol along with it to make it work better. The chronic abuse of the drug has caused his symptoms.
With an aggressive regimen, the drug is cleared from James’s system and his natural intelligence once again emerges. Due to his brilliance, he finds it impossible to relate to his wife anymore, and she herself realizes that he is no longer “the man she married.” While Foreman is trying to explain the situation to James’s wife, he begins to complain that he can’t feel his legs. Foreman evaluates and finds that James has no feeling in his legs at all. The team half-heartedly throws out some ideas including vitamin B12 deficiency, bone marrow malignancy (i.e. cancer of the bone marrow), and lupus, but none of them fit well. House talks to James who admits he had been abusing the dextromethorphan because, while he was intelligent, he was extremely unhappy. He tried to commit suicide once by jumping off of a tall building, but he survived, just busting some ribs. It was while he was in the hospital recovering from these injuries that he was given some narcotic pain medication, and he enjoyed the way it made him feel dumb. After discharge, he sought out the dextromethorphan because it made him feel the same way. Hearing about the history of broken ribs, House realizes that in the suicide attempt, James injured his spleen, causing it to split into multiple smaller (accessory) spleens. Chase thought he removed the spleen, but he removed only one and James still has several more. His ultimate diagnosis is the same one he started with: TTP. Once the rest of the spleens are removed, his TTP will be under better control. He decides to go back on the dextromethorphan though because he’d rather be dumb and happy than intelligent and alone.
For the second week in a row, There were no major errors that jumped out at me in tonight’s episode. The team did their usual combination overlooking certain findings and overtesting/undertesting (diagnosing renal failure without checking renal labs, for instance). Once again, that’s not to say I have no complaints…As usual, minor complaints are in blue, nit-picking ones in green:
Surely before Chase operated on James, he got an abdominal CT scan to double check the anatomy, and surely he would have seen at least one extra spleen (or unexplained mass) on the scan.
If James’s problem had been due to the DXM abuse, which they said caused brain damage, then clearing the drug from his system would not have returned him to his baseline but would have left behind some permanent damage.
Liver biopsy is not performed that early in someone with liver failure. There is much you can discover with labs and CTs/ultrasounds before you go plunging a needle into the liver of someone who is low on platelets.
Did James have accessory spleens or splenosis? It sounds more like the latter to me, but this is not my area of expertise.
The “Otis Campbell” mnemonic is for seizures, not strokes.
I’m not an expert on street drugs, as shown in my review a few weeks ago, but the affects of DMX that House and James describe don’t match what I see in the literature. Unless they’re saying that James went around high and tripping all the time, which you’d think somebody would notice.
What’s the House team going to do when they encounter someone who actually knows how to close a vent?
So James has Thrombotic Thrombocytopenic Purpura without the thrombocytopenia or the purpura? (OK, they implied a low platelet count late in the episode when they mentioned pancytopenia, but that was the only mention. Purpura? Never mentioned).
Schistocytes can be seen in other conditions besides TTP. DIC, for instance.
The team just gives up when James can’t feel his legs? And this is House’s All Star team?
Whatever happened to the ADAMTS13 testing from the beginning of the show? Might it have remained unmentioned because it would have given the final solution away too early?
Convenient how it was mentioned in the beginning that James’s CT was “clear”, but it was never mentioned what the CT was of…
A few brief words about the soap opera: while I enjoyed the way Cuddy tricked House, I found most of the Cuddy/House/Lucas scenes to be excruciating. On the other hand, I appreciated the fact that both Chase and Taub (especially Chase) were shown to be more devious than previously suspected.
The medical mystery was pretty good this week, but more due to the patient than the mystery itself. I give it a B. The final solution made a certain amount of sense. Spleens can “multiply” after trauma, and there have been cases where doctors removed the largest thinking it was the only one. I give in another B. Overall, the medicine was fairly strong, and earns yet another B. The soap opera had a few good parts, but was weighed down by the House/Cuddy/Lucas scene earning a meager C.
Last week’s House review
A list of all prior House reviews
November 23rd, 2009 at 11:32 pm
I still want to know how a hospital justifies keeping a doctor that treats one patient a week, lol.
November 23rd, 2009 at 11:46 pm
What…the…hell….is….wrong….with….Cuddy? as she been bamboozled by House SO MUCH over the years that now, when House is actually acting less of an ass then normal for him and WANTING to be in her life that she can’t see it? or maybe she doesn’t care any more?
Looks like Lucas the douche is back for the foreseeable future.. too bad b/c as a character interest for Cuddy…he plain sucks.
The forced drama ‘tween Foreteen felt contrived at best and was mostly flat…meh comes to mind….
Taub was BRILLIANT in using Houses broken face to get a lil action from his frost queen wife… :D
Looks like next week, what goes around comes around as House seems to finally be reaping what he sowed by messing with Cuddy the last 5 seasons…. She seems to be through with him but will/can it last?
And last but certainly not least….Chase. That boy has got some major bad mojo he needs to deal with….slugging House to make the others too scared to talk to him about Cameron is just weird thinking…
I’ll have to re-watch it again but this episode to me seemed to try too hard in too many different directions and ended up doing nothing particularly well…
“It is what it is” seems to sum this episode up perfectly and that really should have been the name of it..
November 23rd, 2009 at 11:50 pm
Haha, yeah, but their not just gonna go House, you don’t see enough patients. Your fired. End of TV show.
Good review, I liked the episodes, but the whole drug abuse didn’t seem to make sense. Granted, I’ve never used any of said drugs, but I’m not sure how he could go 12 years of using drugs without ANYBODY noticing that he’s high, or suffering from any other medical problems with the drugs.
November 24th, 2009 at 12:02 am
without doubt, the patient was the most interesting thing about the episode… the look on his wife’s face when he tried to explain the the creation of energy from subatomic particles!!!(maybe higgs boson possibly added in too?) sorry i am a physics student!!! glad that you thought the patient was brilliant too, Scott…
i liked it when house spoke to the patient too… two geniuses together and both uninterested in their appearance….
i felt for House, Cuddy really is a bitch especially screwing with him on thanksgiving and not accepting the tickets… you are right scott, i didnt like the house/lucas/cuddy scenes… but chase/house was good!!!
November 24th, 2009 at 12:06 am
I was wondering if the writers were ever going to mention the uncanny resemblance between Omar Epps and Mike Tomlin.
November 24th, 2009 at 12:07 am
You’d think a DXM junkie would have more than one bottle on hand.
November 24th, 2009 at 12:18 am
the clinic was hilarious too..
Female Patient:do you ever shave?
House: once a week, and you?
November 24th, 2009 at 12:42 am
I actually enjoyed all the drama…asides from the aforementioned love triangle, which I was a dedicated meh on.
@Scott – I re watched that part of the episode to make sure, but he wasn’t taking the Alcohol to make the DXM work better. “Long term use causes brain damage, unless taken with the proper amount of ethanol”. Apparently the shot of alcohol was medicinal.
As to the validity of that… dunno. I’ve never heard anything about alcohol staying off the brain damage caused by regular DXM and wasn’t able to find a reliable (or any) source that claims this in a cursory google search, though I would be interested in if there is any validity to it if you would indulge me. The only relevant thing that I’ve read is that DXM HBr can actually help resist some forms limited forms of brain damage.
As far as the described effects, well. I very rarely indulge in drugs, though DXM would be the one that I go to when I do. At a stage one dose, you’ll have mild euphoria, and seeing as how it is a dissociative, some “dumbing down” is evident. While an inexperienced person might have difficulty, functioning normally in a stage one state is possible. If your -that- intimate with the drug, not showing signs of being high would be second nature.
As far as it being as clean cut as “Well, your IQ is off the charts, so if you take some DXM you’ll get knocked down to functioning at a smart, but relatively normal, level” is just standard TV bending reality to tell a story.
DXM does cause permanent brain damage if used in large doses and/or frequently, which is why I’m curious as to their claim of alcohol somehow preventing that.
As far as potentially using it as higher doses and functioning, stage 2 is somewhat similar to ecstasy effect with most people, so that’s a quite bit harder to function normally, let alone hide. stage 3-4 generally leave you with little-no actual awareness of the world around you due to induced sensory deprivation, so..yeah. Best guess is that if its even remotely accurate it was a low dose.
Though, another weight against it. DXM tolerance builds fairly quickly and takes a long time to wear off. The sheer amount that he would probably have to be taking is pretty staggering to think about. Unless alcohol really is some sort of miracle shield, I doubt he’s getting by without at least minor-moderate brain damage.
November 24th, 2009 at 12:53 am
I’m still reading your blog Dr. Scott, but this is the first week I’ve taken the time to comment since this week had a lot to do with pharmacology. It’s late so I’m not going to write a 3 page rant on all the errors of this ep … Just wanted to say that the medicine seems about on par with Gray’s Anatomy.
Dextromethorphan is an extremely safe drug — therapeutic max daily doses is 120mg/d; ingestion of <10 mg/kg is unlikely to produce toxicity in CHILDREN. Adults have tolerated up to 960 mg/day with minor adverse effects. I'm not sure how his wifey managed NOT to notice all the bottles that he would need to be downing on a daily basis to get his desired CNS dwpression — for *12* years! Hashish would have been a more relalistic drug!
Cant' the team check a CrCl?!?!?!!? Maybe that could clue them in about the kidney status …. And then what was that white gunk House injected into the pt before he was put in the tubey thing? It better not have been IV contrast!!!!!!!!!!
-Pharmacy Student
November 24th, 2009 at 12:57 am
“I still want to know how a hospital justifies keeping a doctor that treats one patient a week, lol.”
He gets 3 (now 4) fellows working for him, probably at half the price they would normally go for, and they do clinic hours etc. Plus, they do all their own procedures, lab tests, and radiology reads. And they save a ton of money by not running routine lab tests when patients come into the hospital.
But then, they do waste time suggesting “polycystic kidney disease” after they’ve done a liver biopsy with the kidney in perfect view.
The Mike Tomlin thing was hilarious, though.
November 24th, 2009 at 2:56 am
damn it… How could Cuddy do that to House? selfless BITCH!!! Ahhhh I hate her.. House should better do his revenge!!!
November 24th, 2009 at 3:02 am
i thought the L word will be said in episode 9? I cant believe House makes himself pathetic…
November 24th, 2009 at 3:36 am
I got a chuckle out of the name of the patient:
http://en.wikipedia.org/wiki/William_James_Sidis
November 24th, 2009 at 4:39 am
I may be way off here, but didn’t they say that the ethanol neutralised the brain damaging effect of dxm? ie. he was using with the cough syrup and medicating with the vodka.
November 24th, 2009 at 5:16 am
Tom, that is what they claimed in the episode. Being that I know nothing about the drugs, I can’t confirm or deny that statement… But that is what the episode claimed. I did some searching on the internet. In my limited search, I found a couple of drug forums where druggies claimed they had read theories about it… More interesting, IMO, was the list of meds with DXM in them, and how like half of them have ethanol in them, and half are ethanol free. Not that I know what that even implies…
Also, just kind of worth throwing it out there… Cognitive Deterioration from Long-Term Abuse of Dextromethorphan: A Case Report
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1188627/pdf/jpn00057-0057.pdf
November 24th, 2009 at 6:43 am
I can see how a brilliant guy could feel like an unhappy misfit, but he had to go all the way from mental superstar to subnormal to achieve happiness?
Interesting that in a far more subtle way, House’s situation reflected the patient’s. For the first time–and in the pursuit of love–House can’t outwit others in this episode and is in fact outwitted by them.
The medical solution on this one was really interesting–and even possible, how about that? But except for a couple of glimmers of life from Taub, the soap opera was boring and contrived, and though it’s an interesting premise that all of these people are here (on House’s team) because they placed diagnosis over achievable love, it doesn’t do much for the watchability of the show.. (And unlike them, the patient chooses love.) I like Thirteen’s new eyeshadow, though.
November 24th, 2009 at 7:15 am
Frankly the medicine here was so out of my league for the first time I came here just to get it clear and understand it. Thanx Dr. Scott :) For the soap opera part – I enjoyed it…to a level. Cuddy has never been so mean! It was out of character for her I think. Apart from that she and House are really on the same wavelength so it is pretty much impossible to trick each other all the way. Cuddy won one hand this time but was House really trying? Did he actually try to break her with Lucas? Or was it that he wanted to win playing fair and square instead of using tricks? I guess we’ll see soon. IMO he will see Cuddy/Lucas falll apart by itself soon enough. I was/am still hoping for Mira Sorvino to come back for a few episodes ever since season 4. It would be nice to see House actually getting some happy action instead of just sympathy one. And it will be nice to see Lisa “Ice” Cuddy jealous again. Fingers crossed!
November 24th, 2009 at 7:20 am
@ choi: I believe that House has to mean it (Care) for it to matter… In this episode he only said it as a way to TRY and get Lucas to break up with Cuddy that ultimately failed.
It was all part of his plan to get Cuddy and Lucas apart and at least for now doesn’t mean that much to him..
November 24th, 2009 at 8:10 am
IANAD, but isn’t a suicide attempt that breaks several bones something you’d see in a patient history?
On another note, is Mrs. Taub a shallow cow or what?
November 24th, 2009 at 8:16 am
thanks for the review, good to see the team actually checking patient house again, lolz, this season heading up that House really can ‘change’, he managed gave patient smile after the clinic
and House did not change things, letting his patient dumber, not like in the past, he has a friend, tried to split people up and successful, and redeem himself by lying to his friend daughter that think that he is the dad
still some follow up on Chase arc, the punch is cool, actually Chase is really House protégé, just like what Cameron said, still there are room that either he just acting he was cool or just hiding,
don’t know why, seeing Wilson chatting with House, is so funny
November 24th, 2009 at 8:53 am
I’m sorry to bring this up a week late perhaps, and at the risk of starting a Ginger or Mary Ann string I have to say that I always found Cameron to be more attractive than 13. BTW, I have always said Ginger for dating, Mary Ann for life.
November 24th, 2009 at 9:02 am
Just a nit in that you put “DMX” in place of “DXM” next to one of your green bullets. I’ve heard the former acronym used to denote the bronchodilator theophylline (as dimethylxanthinine).
Dextromethorphan is an NMDA antagonist and has been shown to cause neurotoxicity in rodents. If I were a supersmart megaintelligent ubergenius and wanted to make myself more compatible with my wife, I think maybe I’d have opted for benzodiazepines. If I wanted to supress my cognitive ability, maybe haloperidol or topiramate–or I’d just watch this season of House.
November 24th, 2009 at 9:03 am
Hyperalbuminemia in RENAL Failure?!?!?! what?!
Liver failure causes HYPOalbuminemia!!!
and how about taking blood chemistry as done in every reasonable practice and looking at liver and kidney function!
November 24th, 2009 at 9:08 am
I hated the episode…
(No haters please)
Its great that at least they’re not messing up the medical part so much but if I compare it to the old cases, this one felt like an easy breeze…
AND THE HELL DID THEY DO TO THE WITTY, CONNIVING AND U-BER JERK DR. HOUSE?!
I know, he’s trying to change for the better but… SERIOUSLY?! I starting to feel like he’s now being a push over and after watching the preview for the next episode… *sigh*
I’m a HUGE Hugh Laurie fan (even before House). I hope Shore and Jacobs will get their act together. Mr. Laurie DESERVES better material than what they’re giving to him now. I’m really miss the old House, from season 1-2-3…
I don’t want another Grey’s Anatomy and I’m starting to feeling like starting to be one… If they DO plan to start making it a DRAMA-medical, not a MEDICAL-drama, they better start making better drama because the Huddy thing they’re making really sucked.
PLEASE IF THE WRITERS OF HOUSE ARE READING THIS, BETTER MATERIAL PLEASE!!!
God… A lot of my friends already stopped watching House and I don’t want to end up doing the same but after this episode… I’m starting to think about it…
I don’t want to stop watching House. I really REALLY love the show, (I also Love Hugh Laurie and the character House)… But I really hope things will get better.
November 24th, 2009 at 9:16 am
The DXM addiction part spoils the whole episode… if you know anything about DXM, that is… the guy didn’t permanently damage his brain, because his powers came back… so he must have used it in fairly large ammounts all the time, to impair his intelligence… DXM is very potent, unpleasant chemical, with horrible side effects… so… why, didn’t he experience, any withdrawal, when he was in a hospital for a few days… how could anyone not notice anything (lack of coordination, slurred speech, itching)… how could he deliver packages, when DXM severly impairs you motor abilities… and finaly for the love of god the guy is fat, how could he eat when most common symptom is nausea…
November 24th, 2009 at 9:18 am
What’s with the Cuddy-hate? The trick with the Thanksgiving dinner might have been mean but she is in no way obligated to return House’s feelings. Hell, she wasn’t even mean about it, just honest and blunt. Hate on the writers if somebody needs to be hated..
November 24th, 2009 at 9:19 am
Holy crap, return of the clinic AND an interesting patient of the week all in one episode? I have faith for this season yet…
I actually liked the “soap opera”. Taub and Chase made the show, but the House/Cuddy/Lucas triangle was pretty amusing, if for no other reason than seeing House being nice to clinic patients to woo Cuddy. Oh, and being tricked by her after his wooing supposedly worked. (lol, I was told I should offer you a turkey sandwich! Nice move, Cuddy, nice move!)
November 24th, 2009 at 10:08 am
I enjoyed this episode. And for football fans, I’ve got to get a closer look at the sidelines of a Steeler game, but from memory, Tomlin does look a lot like Foreman! And thanks to whoever posted the info on the real Sidis. Lots of inside, arcane jokes this episode. Can’t see how anyone could prefer Cameron to Thirteen (you must also prefer Jennifer Aniston to Angelina Jolie…i.e. kewpie doll vs. real live human!)….and calling Cuddy a bitch? You must be kidding! House has known Cuddy for over 20 years and 95% of that time he has treated her like crap. Good for her for getting even..hell, she even felt guilty about that. Too bad. What the writers have, in my opinion, failed to really explain is why House is now so suddenly obsessed with Cuddy. Why does he NOW have to have her after all this time? And if he got her, then what??
November 24th, 2009 at 10:46 am
This episode made me really angry. I know plenty of brilliant people, including MIT graduates, and no, being smart doesn’t mean you have to be unhappy, and no, you don’t have to dumb yourself down in order to have a successful relationship with a person of more normal intelligence.
There are many kinds of intelligence. My former husband didn’t have as much book larnin’ as I, but he was a brilliant musician. Which of us was more ‘intelligent’?
The guy wasn’t unhappy because he was intelligent, he was unhappy because he was a *dick*, and why didn’t anyone suggest that, instead of doping himself up with opiates, that maybe he might want to spend some time with a therapist to make him a little less full of himself?
November 24th, 2009 at 11:37 am
@John – DXM is unpleasant for some people, generally more often at the higher doses. Mild level doses most people find pleasant. Interestingly enough, the evidence supporting Olney’s Lesions (the brain damage resulting from the regular abuse of cognitive dissociatives such as DXM and Ketamine is fairly weak in humans. While we have confirmed it in rats, there is little evidence that humans actually develop Olney’s Lesions.
If brain damage -does- result from DXM abuse, which is what I’ve tended to hear and tend to lean towards for my own safety’s sake, then as I pointed out in my previous post he really should have some brain damage going on unless ethanol works as offhandedly mentioned.
@Sharon – Different strokes for different folks. Different things make different people happy. What works for some doesn’t for others, and Yada yada. For him, he found that being dumb was the -easiest- way of being happy. While its not as commonly realized, as there are certain mental disorders in relation to being on the left side of the intelligence bell curve, there are numerous ones to the right with most of them being social oriented.
While its not the case in some, or maybe even most, situations, there are a good number of people on the mid-far right of the curve that have a tremendous amount of difficulty relating to people due to their intelligence. While, with like everything, psychological treatment and therapy can help, it doesn’t always. There’s also the fact that there are a small minority of people that really don’t benefit from therapy.
As far as your intelligence question, IQ is treated as a little out dated, but still serves its purposes. It measures your ability in a specific fields. It doesn’t cover things like EQ (emotional intelligence, the ability to understand and relate to other people), musical ability, and other forms of what some now consider intelligence.
What you have to keep in mind is that while the vast majority of us do have the same basic trends and desires, the specific makeup that makes us tick is different, which means that things and situations that you have had aren’t the rule of things. If it was that easy, then psychology would be a hard science rather than a soft one and treatment for what ails your mind and personality would be as simple as a checkup.
November 24th, 2009 at 11:57 am
This show is getting pretty dark. Kuttner’s suicide, a patient murdered, a patient choosing drug-induced stupidity over intelligence-induced unhappiness, Cameron abandoning Chase, and Cuddy giving up on House for someone even more annoying, just when House actually starts to tone down (well, a little).
Looks to me like the way it’s headed is for House’s own suicide, or at least a return to narcotic abuse.
November 24th, 2009 at 12:27 pm
House hasn’t really changed. Every sensitive outburst is nothing but a scam to get what he wants. Cuddy has upped her game, making her a more worthy opponent, but Dr. H. will win in the end.
And now, Chase, who has studied at the feet of the Master, is now exhibiting some of the same qualities. His cold-eyed admission of the reason he punched House was very House-esque.
I love these evil people. :-)
November 24th, 2009 at 12:32 pm
I was fascinated about the relationship between this episode and last week’s discussion of whether House is a genius. The answer this week seems to be “not exactly.”
The patient presents an extreme and warped version of the very problem the writers had House and Wilson discussing many times in the past seasons: Does House’s gift for diagnosis depend on his being miserable (and nasty)? Can he play the diagnostic game if he isn’t always sharpening his wits by manipulating others? James Sidis’s proposal is that being miserable depends on being very smart. High IQ=Low EQ (emotional quotient, as someone said), and vice-versa. If I am a genius, my wife is not even human; I cannot be a genius and simultaneously love her.
So House, at the moment when he is trying to balance the two and believe that being smart does not entail being lonely and miserable, is confronted by a guy who is both much much smarter and much nastier, unhappier, and sociopathic than he ever was.
House likes Cuddy because she is as smart as he is, and also wants to be happy. And of course the clothes. It would be nice if, now that she has hooked Lucas, she revised her wardrobe. I am so glad someone remembered Mira Sorvino–I was desperately thinking about the health-food-nut he met at the end of one long-ago episode.
November 24th, 2009 at 12:43 pm
What’d he say he tripped over? Not a native speaker and can’t really figure it out…
Thanks!
November 24th, 2009 at 12:49 pm
With each passing season, the drama element gets stronger and medicine gets pushed back more and more. I mean, I still love the show, still better than others, but the drama is consuming too much time now.
Actually I liked season 6 up to the porn star episode. In that episode and now in this one, the dialogues seem to lack their usual brilliance, don’t you guys think? The first episodes of season six were pretty good in that respect, for example:
- If you need to talk, I am right here
- Great! Could you be right here somewhere else?
And House’s miming in Dibala’s case, and the “jock itch” monologue was I think one of the funniest moments of House ever. But for these last two episodes the dialogues kind of lack IQ?
November 24th, 2009 at 12:53 pm
I think he said he tripped over an ottoman–a fancy word for a footstool.
November 24th, 2009 at 1:01 pm
That’s sort of what I heard, but didn’t know what an Ottoman was supposed to be – thank you!
November 24th, 2009 at 1:20 pm
The Cuddy/Lucas relationship is NOT BELIEVEABLE. It’s that simple. She supposed to be this high powered hospital administrator… she’s in charge of the place for goodness sakes, and she involved with this guy!?? Every time I see him, I think “loser”. He’s just a complete goof. I figured last night would be his exit out. Nope. We’re stuck with him for the season I fear. “Jump the Shark”
November 24th, 2009 at 1:23 pm
Judy: Why do you think that the patient is much nastier and sociopathic than House? I don’t see that at all. After all, he chooses a simpler life that includes loving his wife. It seems that many “geniuses” are very unhappy. Of course they have low EQs; who can they really relate to other than people like themselves who are extremely rare. And comparing someone like Sidis to your run of the mill MIT graduate doesn’t seem relevant. Lots of folks are very smart. Very few are Einsteins. And maybe being unable to shut your brain off doesn’t often lead to happiness. House is very smart, but he’s no genius. He’s just a misanthrope. Good for Cuddy, Chase and Taub for some payback. And good for House for being able to take a punch!
November 24th, 2009 at 1:26 pm
When they were pondering if it could be B12 deficiency House said something like no anemia’s are macrocytic, which is inaccurate. I have always learned B12 and Folate fit that criteria.
November 24th, 2009 at 1:27 pm
Sorry, I also don’t get why so many are down on Lucas. He was practically House’ s alter ego during many past episodes. He’s extremely bright and perceptive about people. It’s what makes him a good detective. He’s no loser.
November 24th, 2009 at 1:28 pm
He claims to have been tripped over his Ottoman (http://en.wikipedia.org/wiki/Ottoman_(furniture)).
November 24th, 2009 at 1:45 pm
Official Comment
Charlie,
House was saying that since Jame’s anemia was not macrocytic, =it couldn’t be B12 deficiency.
November 24th, 2009 at 2:47 pm
I liked this episode better than the last one. One question to all doctors out there, though – do doctors ever go raid patient’s house?!
It was great to see clinic duty again, I’ve missed it. It makes for some great fun when the rest of the series can often be quite dark.
As for the Chase/House-scene where he explained why he punchced House – well, my first thought was that dysfunctional people seem to share some form of understanding.
November 24th, 2009 at 3:18 pm
As much as I really don’t care for Mrs. Taub, I think she just should have been a Norm’s Wife kinda character, I laughed out loud at that scene at the end where she jumps on him after she though he punched House. I had been wondering what he was really going to do with that picture.
I did like the House/patient mirror in the episode. Kinda gives people an idea of how lonely it can be at the top sometimes.
The only thing I did notice, although I didn’t put it together before they said it on screen, was that the cough syrup stuck out for some reason when they were doing the MNB (Medically Necessary Burglary). Didn’t know why though. I figured if it was DXM that high enough levels to dumb him down would have had some kind of impact on either the standard or “non-standard” tox screen.
November 24th, 2009 at 4:05 pm
For those of you who are interested in the biological sciences and controversy, the paper below has it all. It’s particularly relevant to the real Sidis, an Ashkenazi Jew with extremely high intelligence, and perhaps, as a result, some side effects. Also interesting is the fact that both he and his father died young, of the same cause.
http://homepage.mac.com/harpend/.Public/AshkenaziIQ.jbiosocsci.pdf
November 24th, 2009 at 4:35 pm
@ D-r Bulgaria: “Lisa “Ice” Cuddy” – nice one. seeing her with a child is just awkward…
@I scott & all M.D.s: Is a splenectomy really a treatment for TTP that is still practiced nowadays?
November 24th, 2009 at 5:11 pm
The DXM effects are way off, in fact the whole thing is thrown in as a red herring and an excuse for an anti-drug message. House has changed a great deal ever since giving in to the DEA pressure. They’ve taken House off his meds (which somehow defied reason and caused hallucinations? sorry, no dice with a straight opiate like hydrocodone), somehow there’s no more pain either! They’ve gone from being a somewhat subversive, interesting show, to being yet another puppet of the drug war propaganda.
November 24th, 2009 at 6:34 pm
Chase seems to coming apart.
I thought it was very mean of Cuddy to trick House with a fake Thanksgiving invitation.
And Taub. I have never been able to stand him, but this takes the cake. Lying for sex. Well, one thing that is consistent: no good interpersonal relationships on this show.
November 24th, 2009 at 6:40 pm
@John Robo: I used to use dextromethorphan pretty heavily (At one point I think we all took about 1500mg of it.. had an out of body experience).
I was able to drive, function, go to high school and in one case even work while under the influence (not the 1500mg experience, of course).
If I hadn’t told people I was robo-tripping, they never would have known.
Sure did make me feel stupid, though!
November 24th, 2009 at 6:49 pm
@Rainbow – As someone that supports the rights of people to make their own choices with regards to such things, I fail to see how this episode portrayed an anti-drug message.
1. The character was happy for being dumbed down. There was no big revelation that the drugs were killing him, and in the end they actually didn’t cause any harm to him what so ever. In his eyes, his life was the better for the DXM.
2. Research is up in the air about if Olney’s lesions occur in humans, and they went with the rout that it doesn’t, with him apparently having no long term brain damage despite -daily- use of the drug over several years. That’s a pretty generous stance, really.
While the portrayal of DXMs effects weren’t accurate, they weren’t stretched beyond the realm of possibilities. My experiences with lowest level effects are somewhat similar, enough that I’m at least within eye shot of where he was, and allow for the possibility that it might affect a small number of people in that way.
@Barry – I’m not sure if DXM is standard on “non-standard” drug tests, but at high level doses DXM can flag a false positive for PCP and/or opiates. While for a normal person, a dose that would leave you still functional would be very unlikely (and I can’t find a reliable source that says its happened at all) to trigger this, as I mentioned tolerance to DXM builds relatively quickly. With the amount of time he’s been abusing it, he very well could be at the point where he needs the equivalent of a 3rd-4th plateau dose just to reach any feeling at all, in which case he very well might have flagged a false positive on a standard test.
November 24th, 2009 at 6:53 pm
I don’t know nothing about medicine but I have a question. How can someone walk if their spleen has been broken? I always thought that the spleen and spine was the same thing. slouchypaul@yahoo.com
November 24th, 2009 at 6:59 pm
‘What’s the House team going to do when they encounter someone who actually knows how to close a vent?’
I love this point, but I think this week may be something of an exception. The patient wants to hide the alcohol from his wife, but intends to access it on a daily basis. It seems acceptable that he wouldn’t screw the vent down.
By the way… I love this blog. I’m a technical computer/automotive/weapons guy, and I really groan when any of those subjects come up in popular fiction due to Hollywood’s tendency to maim the subject material (see the numbers IRC video going around on youtube.)
It’s really neat to see a Medical professional’s opinion on house, so I can experience the phenomena from the perspective of someone who knows very little about the subject matter. :)
November 24th, 2009 at 7:00 pm
Firstly, a great huge Lmao at the Mike Tomlin reference, wondered when that would turn up. Secondly, just a tiny thing, Food? In a Pathology lab? That would make my Microbiology professor cringe lol. Overall though, a great episode.
November 24th, 2009 at 7:56 pm
Dr. Scot,
please check this out: http://www.dailymail.co.uk/news/worldnews/article-1230092/Rom-Houben-Patient-trapped-23-year-coma-conscious-along.html
A men was misdiagnosed with comma for 23 years. In fact, he was not in comma, no vegetable state. He was hearing and watching everything all these years. When I just read that I said immediately: locked-in syndrome!
And according to this link http://www.huffingtonpost.com/2009/11/23/rom-houben-man-in-coma-fo_n_367798.html he was in fact diagnosed with locked-in syndrome.
Thanks for your reviews.
November 24th, 2009 at 8:03 pm
@Rainbow: I seriously doubt the writers took the direction they did because of pressure from the DEA. Also, House’s hallucinations were the result of a psycotic break, not from drugs. After detoxing, the brain’s receptors return to normal and pain levels drop. You should read Scott’s review of the first episode of this season.
November 24th, 2009 at 9:17 pm
Oh, to those wondering how alcohol can protect a chronic DXM abuser from developing brain damage, bear in mind that both substances are NMDA antagonists. If DXM does indeed cause brain damage in humans, it is through NMDA antagonist- neurotoxicity. It has been shown that alcohol protects against such neurotoxicity (in adults!). See here:
http://www.ncbi.nlm.nih.gov/pubmed/15518643?dopt=AbstractPlus
I like their reasoning as to how alcohol might pull this off and seeing as the glutamatergic system is implicated in many neurodegenerative diseases–including Alzheimer’s–perhaps the author of this blog can offer an opinion as to whether or not one to two drinks a day of distilled liquor can enhance a person’s neuronal longevity? (So there’s no confusion, lets say 45 mL EtOH each night with dinner).
November 24th, 2009 at 9:26 pm
edit: “lets say
45 mL15 mL EtOH each night with dinner”November 24th, 2009 at 9:39 pm
@ruthinor. My point was not that high IQ=low EQ as a rule. Butt the patient Sidis experiences this in his own life. When he is intelligent, his wife appears to him to be subhuman, approximating a baboon, someone he could not imagine making love to. He chooses therefore to be stupid in order to enjoy her love. When he is intellectually competent, he is an arrogant, lonely jerk who hates himself. He jumped off a building to kill himself.
This is the writers playing once again with House’s uncertainty about what makes him smart (his “mojo”). If he is really trying to figure out how to be both smart and nice (this has been going on all through last season), the patient offers him a pretty grim picture.
House can be nasty, yes. But he has not that I recall compared a woman he slept with to a baboon. He is surrounded with bright people who are supportive. He has not directly attempted suicide. His nastiness tends to be a series of manipulative games–not a complete dismissal of everybody as inferior to himself.
Of course, the is the central character in the show and is therefore much more complex than any POTW, who has to make his/her point in a two or three memorable scenes. (I thought this actor was terrific and convincing as sick guy, smart guy, and dumb guy.)
November 24th, 2009 at 9:43 pm
@Seep – Thanks for the link. That’s…pretty damned interesting. I had always heard that a glass of wine a day was good for your blood and brain, though it seems like there might be more to that than originally thought. xD
With DXM protecting against a few forms of brain damage and ethanol potentially protecting against DXMs (possible) brain damaging side effects, seems like PotW’s brain might have been better preserved than other men his age. xD
November 25th, 2009 at 12:15 am
Judy, thanks for the reply. I guess we’ll just have to agree to disagree here. You say (about House): ” His nastiness tends to be a series of manipulative games–not a complete dismissal of everybody as inferior to himself.” Throughout the series House has denigrated every doctor he’s met, including Cuddy, on many occasions ( exception of Wilson only). In fact, he DOES think that almost everyone is inferior to him. The patient wasn’t calling his wife a baboon, just pointing out the vast difference between her IQ and his. He could say the same thing about anyone with an average IQ, relative to his high one. Heck, the real Sidis was thought to have an IQ of over 250 (I didn’t think they went that high). We’d all be baboons compared to him!
November 25th, 2009 at 12:21 am
Hmmm. If I’m to understand Mr Shore correctly, a supposedly “brilliant physics prodigy” fails to select a building of sufficient height, take into consideration wind velocity, his own body mass, gravity and the nature of the surface upon which he will land (head first) and instead damages his spleen!? A baboon, or any of the African monkeys, would demonstrate far superior intelligence regarding this subject matter.
November 25th, 2009 at 2:10 am
Locked in Syndrome must be the most frustrating problem of all. thank you for the interesting link Dr. Scott and I wonder what prompted the neurologist to have the patient undergo the hi tech test.
Happy Thanksgiving,
J.D.
November 25th, 2009 at 2:25 am
I haven’t seen this episode yet, but the description reminds me of the classic short story “Flowers for Algernon,” by Daniel Keyes, in which Charly, the protagonist, is a retarted man given a treatment that makes him superintellegent, and due to his subsequent unhappiness, decides to go back to being at his regular IQ level. It also reminded me how “smart” people on TV are usually depicted with Asperger’s Disorder (aka as per Hollywood’s understanding: socially ignorant in all ways). Or they’re just jerks. It’s a trick to make all us viewers of average intellegence feel better about ourselves. ;P
November 25th, 2009 at 3:47 am
I don’t think of myself as a genius but I am smarter than most, and actually I never met anyone in person whom I consider smarter than me, so I can tell you that the patient’s predicament is 100% accurate
I used to wonder about it but now I’m certain, I would be much happier if I were dumb, I wouldn’t be so angry at people for their stupidity, I wouldn’t find the concept of religion and anyone of adheres to it disgusting, I wouldn’t know that life has no meaning, etc
that’s why I hate those House episodes when patients or other doctors try to rationalize why he’s so brilliant, they say that’s because he’s unhappy, because he can’t relate to people, he doesn’t have a life so he compensates with his work, etc
when it’s actually the other way around, he’s special, they’re not, so when they try to find some negative reason for him being the way he is they’re actually trying to justify and feel OK about their own mediocrity, even if they realize it
still, given the choice I would still rather be smart than happy, you know, “the truth will set you free” kinda of thing
November 25th, 2009 at 3:53 am
Hey, I spotted an error with the albumin…..they were discussing his albumin being high….albumin goes down in liver failure because the liver can’t produce it when its not working! And even that happens after liver function tests become derranged so it would be an unlikely isolated finding in early liver failure (unless it was very advanced liver failure and the liver was so destroyed it wasn’t making the usual inflammatory responses it makes when it fails).
Also I agree its strange that the CT at the beginning didn’t show the extra spleens,
Hannah
November 25th, 2009 at 4:25 am
On the matter of the accessory spleens not showing on the original scans, House injected the guy with contrast material prior to the scan. Is it possible that any scans done prior to the splenectomy were done without contrast material and as such the accesory spleens would not have been noticed.
November 25th, 2009 at 4:50 am
Right, what happened to the clinic patients? In Season 5 they practically disappeared from House’s duty. And they were sometimes the best parts of the episode.
November 25th, 2009 at 9:04 am
@ruthinor
re Lucas “He’s extremely bright and perceptive about people. It’s what makes him a good detective. He’s no loser.”
That’s true. It’s why Cuddy is able to be with him. I don’t like him but his intelligence and perceptive skills are important to his character.
When House told Lucas that he loved Cuddy, I believe he was sincere and it was said in a moment of humility. Isn’t this the first time he’s been stoned since rehab? I believe he told Wilson his manipulation plan worked as a way to save face, a lie to himself (obviously, Wilson didn’t know what went on). I think House’s plan failed because for the first time in the show he acted on an honest emotion. He went to Lucas’ house with the intent to manipulate and destroy but got high and had a human moment instead.
However, if he only pretended to get drunk and stayed home from work so Cuddy wouldn’t see that he really didn’t have a hangover then House hasn’t changed a bit and it’s nice to see his plan blow up in his face.
Hmm, I think it’s the former but it’s kinda hard to tell since I watched the show on my ipod.
November 25th, 2009 at 9:11 am
Okay, something’s been bugging me since last week, maybe I just missed the explanation – how did House get the okay to keep FOUR fellows, when he’s always had three before? I know that he was originally trying to get back Taub and 13 to replace both Chase and Cameron, but when Chase decided to stay, House never dropped one of the newbies. So now he’s got four. How did he get permission for that?
As for this episode, I loved it that when PoTW asked House if he’d ever tried to commit suicide, instead of saying “no”, he admitted “not quickly”. I think that was a big admission for him.
Also, I didn’t think the portrayal that PoTW turned into a wife-hating jerk immediately after having his body cleaned out of the drugs was right. I know that some of the love for his wife was from being blissed out on the DXM, but after 12 years those mental associations of love would be firmly fixed in place. He might have some change of heart (perhaps be more easily annoyed with her over certain things) but it seemed to imply that he had totally fallen out of love with her while off DXM, and that he only “wanted to want” her out of a sense of duty and mental-but-not-emotional recognition of what they meant to each other. I don’t buy that.
November 25th, 2009 at 9:20 am
Official Comment
House had four fellows before, the last two seasons: Foreman, Thirteen, Kutner, and Taub. Just swap Kutner out and put Chase in.
And technically, I don’t think Foreman is one of House’s fellows — he was assigned by Cuddy to keep an eye on him, so I guess she covers his pay and House still has three.
November 25th, 2009 at 10:29 am
Several disjointed comments:
To me, House has been a bigger jerk since coming out of rehab than he was before. At least before he had the excuse of being an addict. I think Wilson recognizes that, because he avoids being around House now.
What Cuddy did to House was appropriate payback for all the things he has done to her. Contrary to the opinions of many here, she and Lucas seem like a good couple. They treat each other with respect and act like adults with each other. Why would Cuddy want to give that up for House?
House’s drunken dialogue with Lucas rang true to me (even if he was faking). He really is pathetic now. Cuddy would have to have no self-respect or sense of self-worth to ever be with House now. If he continues his childish efforts to break them up, she should fire him. I think the writers have taken this as far as it can go (too far, really).
In response to doa766: I don’t know what field you work in, but I’ve scored in the top 1% in IQ tests, and I’ve met a lot of people who I think are much smarter than me. Perhaps you have an inflated sense of your own intelligence.
Re: Omar Epps and Mike Tomlin. Other than being black and the goatee, I don’t see that they look that much alike. Their head shapes and hairlines are quite different. I’d be interested to know if any black people think they look that similar.
November 25th, 2009 at 10:53 am
“We’d all be baboons compared to him!” Ruthinor: Please refrain from speaking for us all.
November 25th, 2009 at 11:55 am
@tom: Yes a splenectomy is a procedure for treatment of TTP. It is also routine choice of treatment for a couple of more things (congenital erythropoetic porphyria, certain lymphomas, and if becomes damaged enlarged or ruptured)
November 25th, 2009 at 1:30 pm
Dr Evil: You must have a very inflated opinion of yourself! As for me, I like baboons…we are all primates after all.
November 25th, 2009 at 2:38 pm
Still not getting the soap, shall I give up on that? The case was no better to me anyway.
1. The third repetitive diagnosis this season. Seems like the writers ran out of new diseases.
2. No purpura also confused me.
3. No one noticed splenic injury?? Should have been serious internal bleeding!
November 25th, 2009 at 2:40 pm
Anyone notice that in the last scene with Cuddy and Lucas, when Cuddy walked into the room, her daughter didn’t make any eye contact. Not at all like a young child seeing her mother after an absence.
Totally unrealistic, a poor performance by the young actor. :-)
(Note to the humor impaired: this is a joke; I am not seriously critiquing the performance of a one year old actor.)
November 25th, 2009 at 5:18 pm
If I was House, I would of tried hitting on the house-sitter! She was cute.
I know I stand alone on this (except for Hank G), but I kinda like Lucas. Yeah he’s a dumbass, but he’’s also kind, caring, compassionate, cooks, cleans, and is ALWAYS THERE FOR CUDDY AND HER CHILD! Things House, no matter how much we wish he would, is simply incapable of doing, Vicodin-free or not (especially the last one. Honestly, would YOU want House raising your kids?). If Cuddy ever does dump Lucas, it will have to be for something Lucas does, not something House cooks up. Lucas is not a bad guy, we just WANT him to be to justify Cuddy leaving him. And so far, his worst crime seems to be being a bit of a dumbass.
November 25th, 2009 at 8:15 pm
@Randy
lol yeah, I was “wait….” when I heard the dudes name
November 25th, 2009 at 8:27 pm
Just a comment on splenectomy to treat TTP? I had my doubt on it and went to look it up on uptodate and found that splenectomy is not a proven or reccomended therapy for treatment of TTP. Plasmaferesis, steroids and anti platelets products would be the preferred treatment. Agreed on the fact they conveniently got rid of plasmaferesis with the alergie, but I am quite confident you want to try a few more therapy before you surgically remove people’s organs. But its House… he is always right and do what ever he wants :)
November 25th, 2009 at 9:35 pm
At first I was laughing at the idea the patient was on DM cough syrup. My friends and I did this quite a few times throughout college. We’d down 2-4 ounces quickly, occasionally mixing it with pot or a beer. As best I can remember, the effect was something like being on LSD after the peak with a tranquilizer thrown on top. It be hard not to know a person doing this was on some kind of recreational drug. And usually people who did this would vomit within 30 minutes of drinking it. And the effects weren’t very predictable. An experienced person could be fine on 4 ounces one night, then next weekend have a really horrifically bad trip on 2 ounces.
It’s possible that the patient here was more experienced, starting with smaller doses, and had built up resistance to the effects. But a smart guy like that probably would have experimented with and found something via an online pharmacy that was less harmful and more predictable. You could probably function on DM at work if you had to, but there are other medications that would slow a person down mentally without the added trippy-distractions that DM-tripping brings.
November 26th, 2009 at 1:21 am
the supposed use and effects of dextromethrophan in this episode was hilarious. when did this show turn into such a conservative vehicle? all these subtle morality messages against casual sex, bisexuality, drug use … or the “God works in mysterious ways” themes… insidious!
November 26th, 2009 at 3:59 pm
@Ruthinor: Only slightly higher than doa766. “I do think of myself as a genius and am certainly smarter than ALL and actually…. I will never meet anyone in person or online that is remotely as smart as me. So I can and will tell you as a more reliable witness than my predecessor (doa766) that the patients predicament is 100% accurate.” : )
November 26th, 2009 at 11:00 pm
OK. I’m not going to sit by while some idiot says nobody would pick Cameron over 13. I most certainly would. So there. She is a classic beauty and a truly good person. She also has a better body. Take that!
November 27th, 2009 at 1:30 am
@DrEvil & doa767 — Perhaps the social misfit problem has to do more with being a child prodigy as opposed to just being a genius who is allowed a normal childhood?
I doubt that a sample of two is a large enough sample to make a statistical inference on a correlation between genius and social behavior. After all, on the side of geniuses who seem to be able to function normally, I can come up with Linus Pauling and Kim Ung-yong and of course there is myself. . . HAHAHAHAHAHAHA. . .
November 27th, 2009 at 2:09 am
Sample of two, not so much. But what studies I’ve seen do seem to suggest a correlation between higher IQs and certain social difficulties/disabilities.
November 27th, 2009 at 2:33 am
@ Leon: My apologies Leon. I wasn’t really arguing that point. Rather, I was making the point that considering oneself smarter than those around you, and making inferences based on one’s behavior therefore because of, does not necessarily lead to an accurate world view.
November 27th, 2009 at 7:02 am
I think some are missing the physiology on why someone is unhappy. Everything must have a physical cause in order to exist. Such is true with the brain. Chemical reactions cause emotions. There may indeed be a link with negative emotion and intelligence, however, one is only unhappy (even due to circumstances) because of a lack of certain brain chemicals and the ability to use those chemicals; dopamine is involved greatly in this. DXM and other opiates, along with other illicit drugs, cause dopamine to be increased in the brain or be used more readily–thus happiness. The patient’s lack of misery has nothing to do with him being “dumber”.
November 27th, 2009 at 11:04 am
@lewfalo – Psychology is one of my majors, so I understand where your coming from. Yes, neurotransmitters do regulate emotions, but the neurons regulate neurotransmitters, and the process of firing thoughts and the combination of determine what degree and combination of such are released when.
Its not as simple as “the chemicals are out of wack”, emotions are an -extremely- complicated thing tied in to pretty much absolutely everything going on in your brain.
November 27th, 2009 at 3:39 pm
@Leon – yes, I wonder if the mysteries of the brain will truly be solved. But I’m sure you agree it all has to do with physiology in one form or another. The fact that endorphins are similar to morphine on the molecular level is fascinating. However, nothing can match the euphoria that morphine brings…It’s also interesting that opium even exists in nature and has that effect on us. Are you aware of the book Botany of Desire? Suggests that plants actually use us for their own purposes.
November 27th, 2009 at 5:35 pm
@Lewfalo – Yeah, everything ultimately comes down to physiological facts, but how/what we think partially controls that, which is controlled by physiological responses… >_>.
And I wouldn’t be suprised. Humans are generally super self centered and tend to think of themselves as unique and more important than everything else on the planet. They tend to forget that everything evolves, not just us. Not that I’m arguing that were not the “furthest” evolved, just that we tend to overlook the intricacies of nature.
November 27th, 2009 at 10:08 pm
you can actually appear quite normal on a first or second plateau dose of DXM, although at a strong 2nd you probably wouldn’t want to.
November 28th, 2009 at 1:37 am
Dr Evil. That was so funny! I don’t understand why James married his pArtner if he wanted someone in his league mentally so to speak. It’s all a bit silly to be honest. He must have seen something in her that was strong enough to overcome this. My husband is much cleverer than I am but we love and respect each other and are very very happy and have 4 beautiful happy children.
November 28th, 2009 at 3:51 am
Hey! Who the hell says 13 is hotter than Cameron? I STRONGLY disagree. Cameron is way prettier, way hotter and frankly a better character overall. As for 13…well there is something about Olivia Wilde that just does not work for me. Frankly during the race for fellows the other females involved got to me more (not to mention Amber! Smoking hot! Anne Dudek by herself is hot, Anne Dudek + CB = way way hotter!)
November 28th, 2009 at 3:51 pm
one thing did make me jump from the chair is when thirteen brought some sandwiches and walked in to the lab and start eating……
yup,me a science rat who knows his rules
November 29th, 2009 at 2:59 am
Nobody has to take doses of cough medicine to dumb themselves down. All you have to do is watch Fox News for a few days and your IQ is zapped. (One day if you watch Glenn Beck.)
November 29th, 2009 at 7:06 am
@Jenny: Shiny Happy People (REM). : )
November 29th, 2009 at 12:50 pm
I do get some good chuckles when I visit these reviews…I am curious, Dr. Evil, are you a fun person to be around, or are you so arrogant that people dislike you? Most people think I’m very intelligent, but there’s nothing I like better than to meet someone smarter than me and picking his/her brain.
November 29th, 2009 at 12:56 pm
BTW, does anyone know if Taub was named after the Edward Taub, neurosurgeon? http://en.wikipedia.org/wiki/Edward_Taub
November 30th, 2009 at 2:56 am
@Jen: I think Dr Evil was talking to me. I quite like his sense of humour. I wish I could edit my post though. I do sound a bit like that song from REM. Oh well. Never mind.
November 30th, 2009 at 6:33 am
For the record, I’ve known people who spend the whole day robotripping regularly. It’s harder to notice than you might think.
Kind of bummed that the show decided to reinforce the whole “All smart people are lonely and/or jerks” schtick, again. Oh well.
And the guy’s a moron for planning his marriage around being permanently high.
Speaking of stupid marriages, either the writers rushed the scene, or Taub’s wife is a shallow bitch. Leaning towards the latter.
Lastly, pretty happy that they’re showing all the parts of Chase that I love again, including the fact that he’s always been one of the cleverer members of the team.
November 30th, 2009 at 7:14 am
Long time lurker, first time poster :)
Couple of thoughts:
1) Surely, given the high dose and sustained usage, the DXM would have given a positive opioid result on the tox screen?
2) What was the reasoning behind giving activated charcoal and a gastric lavage to try and detox the DXM out of his system? Surely they only work within a very narrow window of ingestion?
November 30th, 2009 at 11:20 am
I used to use DXM in cough medicine when I couldn’t sleep. It worked, but I realised it was a dangerous game and stopped it. And Now DXM isn’t allowed in UK drugs anymore…
November 30th, 2009 at 8:48 pm
Fiz, DXM is still sold as a pharmacy only medication in the UK. I have a couple of bottles of DXM syrup in my cupboard!
Oh yes, the other point that made me squirm in horror: Eating sandwhiches in the path lab?! D:
December 1st, 2009 at 9:48 am
[quote]If James’s problem had been due to the DXM abuse, which they said caused brain damage, then clearing the drug from his system would not have returned him to his baseline but would have left behind some permanent damage.[/quote]
didn’t house say that ethanol would stave off the permanent effects (affects?) of the DXM? and that was why he drank one shot of vodka a day?
December 1st, 2009 at 9:37 pm
@ruthinor
While I agree with some of what you’re saying, I think maybe you should take some of the studies you’re mentioning with a grain of salt.
The paper you linked to sets off all kinds of skeptical alarm bells for me when I start reading it. Not only the subject matter and the implications of the claims made, but also the nuts and bolts of what the authors claim has occurred, under what circumstances, and the reasoning they appear to be using to back it up. I only skimmed the beginning, so I could be wrong, but this does not strike me as the most solid of scientific work. And anthropology is a pretty “soft” science anyway.
The other thing is the IQ of 250 thing. IQ is, like any other measure of “fuzzy” personal qualities, a somewhat unreliable indicator of anything. It is most useful right in the normal range, where there is enough statistical information available to really fine-tune the reliability of the tests they use and the interpretation of their results. And in any case, there are many different IQ tests which give rather different numbers for different people.
Any estimate of someone’s IQ that goes as high as 250 merits a chuckle and an eye-roll. There is no way to reliably standardize and estimate a statistical quantity like IQ for such a distant outlier, and even if there were, it would be hard to say what that number actually meant, if anything. The best way to describe that guy would not be to use a number, but just to say “really effin’ smart” and leave it at that.
December 1st, 2009 at 11:20 pm
ADAMTS13 testing… What’s the turn-around on that? I agree with everything you pointed out… I enjoyed the drama though.
December 2nd, 2009 at 9:02 am
Sorry to come into this so late; when I can’t record House I have to wait eight days for Hulu *sob*
Anyway, I just wanted to chime in in defense of Mrs. Taub. I imagine most people criticizing her are not married. When you get married all major (and many non-major) decisions are done by committee, and for Taub to make such a huge decision involving his career (which they BOTH sacrificed for) without consulting her is plenty of reason to be angry. My husband’s certainly gotten the cold shoulder a few times he’s made similar bone-headed decisions. Taub has chosen to work for a man that made him miss Thanksgiving dinner and generally treats him like crap and this frustrates her. The reaction to the photo was probably a little overboard, but I can see it giving her a little vicarious release for her frustration. Anyway, I like Taub and the fact that he seems to be the only character to really care about his spouse above and beyond his career (his unilateral decision not withstanding) – yeah I’m looking at you Chase!
December 2nd, 2009 at 12:13 pm
>@Sharon – Different strokes for different folks. Different things make different people happy. What works for some doesn’t for others, and Yada yada. For him, he found that being dumb was the -easiest- way of being happy. While its not as commonly realized, as there are certain mental disorders in relation to being on the left side of the intelligence bell curve, there are numerous ones to the right with most of them being social oriented.
B-freakin’-S that this is somehow inherent in high intelligence. As a person whose IQ is higher (SB L-M–the only one that can give those scores) than the one quoted in this episode and who is frequently in contact with others in the same ballpark, I can tell you frankly that all “social problems” of high intelligence are engineered by abusive socialization, especially schooling. Sadly, the vast majority of highly intelligent people are educationally and socially abused in public or private schools unwilling to accommodate a precocious child’s abilities, but those who are given an environment in which being who they are isn’t treated as perverse haven’t got an elevated level of “problems” of any sort–in fact, they have fewer.
The guy wasn’t unhappy because he was smart. He was unhappy because he was a jerk. Part of his jerkiness was because he was an arrogant SOB, but that wouldn’t have been “cured” by being dumber–and no disassociative/”dumb” medicine would not have simply depressed his IQ in a blanket way. (He might have slurred his words, but he would have used large ones, for instance. His reactions would be slower, but his solutions and thinking still, though bend, far above normal.) This demonstration of how he was “smart” again was howlingly stupid (better than that Spock-like quoting of statistics in a recent NCIS episode, but scarcely), but sadly predictable. Ironically, the “stupid” wife didn’t act dumb at all, except that she talked slowly with wide eyes. Her criticism of the team was spot-on, however repetitious from other episodes.
This episode was a weak attempt at echoing the life of William James Sidis, a phenomenally brilliant man who, at 23, resigned from his academic career and took only menial jobs thereafter. BUT it wasn’t about him not wanting to be smart anymore–it was about him wanting to be left the hell alone. He’d been made into a circus act by his parents from the age of three or so. They paraded him around, sought extreme publicity for him, and made him into a freak. His safety was even threatened by other university students at one point! The ONLY way for him to lead a private life was to leave any activities that would attract the rather salacious attention of the press. He continued to use his intellect–in ways that entertained him, not for his parents or for the public. He became the most knowledgeable local historian and amassed some sort of extremely specialized collection–I forget what. He specialized in the arcane and, to outsiders, the uninteresting and found his outlets there. And he finally got the life he desired–one out of the public eye–for the most part.
For those who can’t understand why he chose very menial tasks, the answer is simple. Physical repetitive tasks that leave the mind free are far less tedious than mentally repetitive tasks that require just enough of the mind that you can’t think freely. Most white collar jobs would be extremely mentally repetitive and dull to a person that intelligent, and the few that weren’t–his university position being one–attracted WAY too much attention from the press. He could be happy as janitor or as a physics researcher, but not as a business lawyer drawing up contracts.
If you don’t think that’s realistic, think of it this way: What would you rather do, build a bookshelf or do long division for the same number of hours?
This has be misconstrued as a genius who “went stupid” or “had a breakdown” rather than the proper understanding of an endlessly hounded young man giving the double bird to the public to which he had been exposed against his will–and finding his own way instead.
December 2nd, 2009 at 12:23 pm
250? I thought they said 170-something.
Whether you can get a number that high depends on the construction of the IQ test. IQ tests that were extrapolated from metal age/age ratios can, indeed, have that high of a score. Those that claim to be strict bell curve IQ tests usually have a hard ceiling around 150 or 160. To me, the extrapolated IQ tests are a great deal more helpful than ones that pretend that compress the upper ranges so much. What we need is a modern, updated one.
Full-scale IQ testing is very useful for making sure there’s no big deficit in bight-and-smarter children, BTW. Brighter children can compensate for specific disabilities that should be addressed directly through remediation–things that will become big problems later on when compensatory strategies are insufficient to make up for the deficient and everything comes crashing down.
I had a friend with extreme dyslexia that wasn’t diagnosed until her master’s program but so crippled her in mathematics that she had a hard time getting into grad school because of her GRE. Her professor finally caught it–”I KNOW you understand the concepts, so I can’t understand why you get so much wrong in your work. Go get tested!” And lo and behold, she had a severe disability that COULD have been addressed many, many years ago and made her life much easier.
December 2nd, 2009 at 6:29 pm
Is it possible that House pushed the rhabdo diagnosis because of his own experience with muscle death?
December 2nd, 2009 at 9:18 pm
I think a lot of the problem with Taub’s wife is that she is the stereotypical crappy wife, right down to not even telling her husband why she’s unhappy with him. She didn’t even want to talk with him about it.
But, of course, she jumps his bones the second he gives her a picture and a poor lie about beating up his boss.
December 3rd, 2009 at 12:30 am
@Reya: Excellent post. People should read it properly and digest! @Mani: I agree with you fully here. @Jennifer Francis: Glad you like my British sense of humour. : ) @ Xezlec: Your post also makes nice reading.
December 3rd, 2009 at 12:36 pm
Some words for real things. I had multiple DXM trips so my opinion would be not only medical, but a drug user one too.
1. Neurotoxic effects of DXM appear after a long-term use of HUGE doses (for Robitussin it would be about 15-20 bottles/week). If the patient used so much, he would have been totally dissociated all day long (6-8 hours for single trip and 6-8 hours for aftereffects). His wife seemed to be not a dumbass, she had to see that her husband is “high”.
2. Robitussin contains Guaifenesin, which causes vomit. In huge doses the vomit should be everyday. Advanced DXM users remove Guaifenesin with simple chemical reactions, so our patient shouldn’t have drink Robitussin from the bottles.
3. Mix of alcohol and DXM doesn’t protect any organ. Effects of this mix are some stimulation and slightly increased symptoms of alcohol intoxication. Alcohol kills in such mixes, not protects.
Sorry for my terrible English and the lack of language practice :)
December 4th, 2009 at 4:14 pm
Apart from the already mentioned William James Sidis, the patient also made me think of “Ben” on the show “Intervention”. 170 IQ and addicted to DXM, which sadly makes him come across as “dumb” when high, as you can clearly see in the intro: http://www.youtube.com/watch?v=DThxSf1eWo8
Coincidence? Hmmm. What do you guys think?
As for the discussion about IQ and happiness, I recall from earlier years in uni (neuroscience) that several studies, including longitudinal studies of exceptionally gifted children, actually disproved the myth that intelligence = miserable and that in fact it was quite the opposite. These children grew up to be productive and adjusted adults, even as far as having “happier” marriages (ie more often stayed married). Apparently, the personality characteristic that actually seems to be correlated with unhappiness is the trait neuroticism, whereas the trait extroversion is correlated with happiness. These are not traits that are intelligence dependent.
I digress slightly, but: I’ve administered plenty of intelligence tests (both Raven’s and WAIS), and I’ve often been surprised by how hard it can be to judge a book by its cover. Even knowing this, I still tend to initially rate the introverted geeks as more intelligent than the outgoing, “wholesome” folks. I suppose it’s a good example of the availability heuristic – that intelligent people who conform to the sterotype stand out more and are therefore more accessible to memory.
DrBulgaria: I agree, bring back Mira Sorvino! :)
December 6th, 2009 at 1:34 am
LOL. People who are not intelligent measuring the intelligence of others.
December 6th, 2009 at 7:56 pm
@Alex Green
“Robitussin contains Guaifenesin, which causes vomit. In huge doses the vomit should be everyday. Advanced DXM users remove Guaifenesin with simple chemical reactions, so our patient shouldn’t have drink Robitussin from the bottles.”
Not all Robitussin contains guaifenesin. There are multiple formulations, and at least one contains only DXM as an active ingredient. There are others with even more active ingredients than just DXM and guaifenesin — APAP, doloxymine succinate, pseudoephedrine (or whatever the new OTC decongestant is that isn’t used for meth production), etc. Drinking robo with guaifenesin will make you vomit due to increased mucous production, and drinking robo with any combination of other active ingredients could mess you up even further. AFAIK, most of the recipes to pull DXM out of cough syrup is to either remove substances that are dangerous at “recreational” doses, or to make it easier to ingest, since sucking down a bottle of cough syrup is pretty f-in’ gross.
From a personal viewpoint, as someone who is fairly intelligent and a former DXM abuser, I never felt particularly stupid on it. At least not in any empirical sense. I definitely felt altered, and used it because I liked the feeling of disconnection (and the way it made my brain process music), but I would definitely not describe it as something that reduced my intelligence. If I wanted to feel stupid all the time, I’d stick to alcohol or barbiturates. And yeah, it’s possible to go about your day and your boring job while on a low dose without anyone noticing. The really noticeable motor effects don’t kick in until the 2nd or higher plateaus, at least in my experience.
December 8th, 2009 at 3:45 pm
I can’t stand Taub’s wife. Most doctors do have to work non-traditional hours; some don’t get home till 8 pm. Patients don’t get sick on schedule, they get sick on Christmas and Thanksgiving. Suck it up, lady. Or admit you’d rather be married to a guy who sucks fat out of rich people’s necks and leave Taub.
December 8th, 2009 at 10:46 pm
“I’m not an expert on street drugs, as shown in my review a few weeks ago, but the affects of DMX that House and James describe don’t match what I see in the literature. Unless they’re saying that James went around high and tripping all the time, which you’d think somebody would notice.”
It’s called NMDA antagonist neurotoxicity, and very few people are susceptible to it. Other than that, the House writing team pretty much has the right of it.
However, DXM is metabolized by CYP2D6. If Dude were on the verge of liver failure, hitting that fourth plateau probably would have killed him outright, so they should have been able to rule that out early.
December 27th, 2009 at 11:03 pm
” I found most of the Cuddy/House/Lucas scenes to be excruciating.”
Another cringe-worthy House. Ever since the 3rd or 4th season.
December 27th, 2009 at 11:29 pm
#
D-r Bulgaria
November 28th, 2009 at 3:51 am
Hey! Who the hell says 13 is hotter than Cameron? I STRONGLY disagree. Cameron is way prettier, way hotter and frankly a better character overall.
- A good character, played out. As for looks, maybe if she’d eat a sandwich.
Amber! Smoking hot! Anne Dudek by herself is hot, Anne Dudek + CB = way way hotter!)
- Aggressive is fun, but her body is much less attractive than you’d think and her face is so-so.
January 4th, 2010 at 11:11 pm
Heh. I got a little thrill out of the mention of polycystic kidney disease, since I was just recently diagnosed with PKD, but I do think it was a bit ridiculous that Thirteen’s reasoning to dismiss the diagnosis was about the UTIs and flank pains, rather than the random imaging studies they must have done which would show cyst-free kidneys. After all, it’s not like PKD always causes constant UTIs/flank pains – that’s why it usually goes unnoticed for so long.