House — Episode 10 (Season 6): “The Down Low”
This episode seemed like it was trying to be a cross between House and Brotherhood. A novel approach, but the medicine suffered for it.
In a dark garage, a drug deal is going down between two groups of mobsters. When one of them gets antsy and starts flashing a gun around, another of the mobsters jumps him. In the struggle, the gun goes off and one of the combatants slumps to the ground. It turns out he wasn’t shot by the gun — he just collapsed.
A little while later, House is sewing up the Mickey the mobster’s forehead laceration. Being quick on the uptake, House realizes what line of work his patient is in. He suggests Mickey stay in the hospital for a work-up, but he declines. As Mickey and his partner leave the room, House slams his cane into the table and the sudden loud noise causes Mickey to collapse. He gets admitted to the hospital after all.
House presents the patient to the team as a “32 year-old man who recently developed loud-noise induced vertigo.” There is no medical history as Mickey does not want to share anything. Foreman suggests the cause must be in the ear or brain, and since a brain CT scan was negative, it must be in the ear. He suggests an acoustic neuroma (a tumor of the eighth cranial nerve, the nerve involved with hearing). An ABR is ordered to test for the neuroma (An ABR — or Auditory Brainstem Response — is a hearing test that looks specifically at the nerve component of hearing. If you’ve seen a hearing test done on a newborn in the hospital, you’ve seen one of these) . House announces that the diagnosis might be lidocaine or benzocaine toxicity, as both chemicals are commonly used to cut cocaine.
While the team runs the ABR, House talks to Mickey’s partner Eddie who swears that Mickey never touches the cocaine. The ABR is normal, but Mickey has a seizure during the test, which Foreman announces must be due to his elevated blood pressure. Mickey is started on a vasodilator (a blood pressure medication that works by dilating — opening wider — his blood vessels) and his blood pressure improves. The differential now consists of sick sinus syndrome (the heart’s “pacemaker” isn’t working right), carotid stenosis (narrowing of the carotid arteries), or toxin exposure. A carotid ultrasound (to look for the narrowing) is normal. Figuring the cause must be toxin exposure, the team discharges Mickey with the plan of trailing him back to his hideout, but he manages to ditch them.
Mickey is brought back to the hospital several hours later delirious with a high temperature. He is given antipyretics (fever reducing medicine, usually acetaminophen [Tylenol]) and “soft steroids” (basically, a specially engineered steroid with less side effects. Sounds nice, but doesn’t really apply in this case. Technobabble) The differential diagnosis now consists of an environmental exposure (but House figures Mickey wasn’t out of the hospital long enough to be re-exposed) or an infection. A lumbar puncture is performed and shows no sign of infection. Chase notices that despite it being a poorly performed lumbar puncture (and therefore qutie painful) , Mickey’s heart rate never budged when it should have shot up with the pain. Chase suspects Mickey has autonomic dysfunction, but House doesn’t think the symptoms match. He confronts Mickey who admits that he’s been taking a beta-blocker (a blood pressure medication that slows the heart rate) for his nerves.
Given the symptoms of vertigo and fever, and Mickey’s high stress occupation, the team decides he must have “excess adrenalin” and probably has a pheochromocytoma (a tumor that pumps out high levels of adrenalin and similar compounds). An MRI of the adrenal glands is negative, ruling this out. Once again, the team decides the cause must be environmental. Meanwhile, House had bugged Mickey’s room so he could learn more information about his background, but the bug never worked well. Eventually, he realizes that something is interfering with it and suspects that it’s another bug in the room. Sure enough, he finds a second bug and deduces that Mickey is an undercover cop. He reluctantly admits that House is right. Suddenly, Mickey experiences severe abdominal pain. Later, Chase reveals that he suffered a GI infarction (the blood supply to the bowel was cut off, causing some of the bowel to die. Like a heart attack, only of the bowel) of the superior mesenteric artery, and a foot of his bowel had to be removed.
Reviewing Mickey’s symptoms of vertigo, fever, and clotting (the high blood pressure is discounted because it is felt to be a rebound high pressure from skipping his medications), the team decides yet again that it must be an environmental exposure. Thirteen leans on Eddie who agrees to take her to the hideout. It turns out to be a dry cleaners, and she takes multiple samples — but they all turn out to be negative. Just as the team is stumped, Mickey starts coughing up blood. A VQ scan (ventilation-perfusion scan) of the lungs shows a pulmonary aneurysm (a bulge in the blood vessels in the lung), which Chase surgically repairs, but the next morning, three more have appeared. House and team decide this must be a fungal infection and start Mickey on antifungal medication, but it doesn’t seem to be working. Totally out of the blue, House deduces that Mickey has Hughes-Stovin Syndrome, an autoimmune disease. Unfortunately, by the time it’s reached this stage it is fatal and according to House, Mickey has but a few days — or hours — to live. House’s prediction is true, and Mickey dies in the arms of his wife a little while later.
Lots of errors this week, and several big ones, too. As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:
Hughes-Stovin Syndrome is not a good fit. True, once the aneurysms start rupturing the patients often die (but even then there are treatments that have been tried — sometimes successfully — and since when has House’s team just given up like that?)
The aneurysms do not appear overnight, but appear over time.
Hughes-Stovin Syndrome is associated with venous thrombosis — but the patient had an arterial thrombosis — a different animal all together.
There is a good chance the steroids given earlier would have helped the Hughes-Stovin Syndrome.
10-20% of pheochromocytomas occur occur outside the adrenal glands, so a negative adrenal MRI would not rule them out (especially in House’s world, where the uncommon is common).
The superior mesenteric artery is a major blood vessel and supplies much of the bowel with blood. A blockage in it would cause the patient to lose more than just a foot of bowel.
Despite having a diagnosis of “vertigo”, the patient didn’t really show much in the way of vertigo. Sure, vertigo can cause drop attacks (from extreme dizziness and loss of balance), but the patient never complained of any of those symptoms. The drop attacks looked more like those cataleptic goats.
It’s quite a jump in logic to decide that the high blood pressure caused the seizure. There’s so many other possible causes. For instance, Lidocaine toxicity — House’s suggested diagnosis — is well known for causing seizures.
Did I really see Foreman jam something in the mouth of seizing patient? In 2010? He’s a neurologist, he should know better.
Expect to see results from antifungal medication in a few hours? Nonsense. That would be fast for regular antibiotics, let alone antifungals which are slower (as I tell patients in the office, fungus grows slowly, so it dies slowly).
If Mickey took enough beta-blockers to not respond to pain, then he would have an extremely low heart rate, definitely below sixty and probably even lower.
Beta-blockers do not cause a noticeable rebound high blood pressure. Certainly not one high enough to cause a seizure.
A VQ scan is a logical approach to diagnosing coughing up blood (looking for a pulmonary embolus), but isn’t good at showing aneurysms. The image Chase showed was way too clear for a VQ scan (here’s what one really looks like; very fuzzy) — it was probably a CT.
Is Foreman really expecting inhaled Albuterol to fix what is clearly a systemic problem?
It was strange the way the writers were being very coy with medications this episode: “vasodilator,” “antipyretic,” and “soft steroid” rather than actually naming the drugs, like they always (or almost always) have before.
It was hard, but you’ll notice I made it through the entire review without resorting to a “Can’t Hardly Wait” pun.
The scene in the clinic (at least I assume it was the clinic) where House deduces the source of Mickey’s injury was well done, and very Holmesian.
The medical mystery was okay, but I question if the patient really had what they said he had — I give it a C. The final solution was a big stretch, and in shooting for pathos, they shortchanged the team. It gets a D. Overall, the medicine was more often than not, painful to watch: another D. The soap opera was quite good though (with this week’s theme seeming to be “deception”) and earns a solid A.
The review of the previous episode of House
A list of all prior House reviews
January 11th, 2010 at 11:25 pm
I liked Maggot Brain towards the end of the episode. http://www.youtube.com/watch?v=dh3bleXWaCk
I thought it was kind of funny that House can’t get a good connection with the bug and deduces that there must be another one and in one grab pulls the one he didn’t plant from under the bed.
January 12th, 2010 at 12:13 am
Hmmm…. Time to shake off the rust that a long mid-season hiatus will bring..
Definitely an interesting episode for certain and one i’ll probably need to watch again just to be certain I got all the nuances..
Not a stellar ep but also not filler either…
January 12th, 2010 at 12:33 am
@Ross, I figured that he deduced where a genuinely ill patient would be _able_ to put a bug and looked there first. If you notice, he does has to search for a few seconds before he pulls the 2nd bug out.
January 12th, 2010 at 12:35 am
Er also, not getting the “Can’t Hardly Wait” reference… hope I’m not the only one.
January 12th, 2010 at 1:27 am
Best line: “They never call.” by 13 regarding bad boys.
Runner-up: “We’re two tigers away from having a show in Vegas.” by House.
January 12th, 2010 at 1:49 am
Do you think they could have come up with another fatal diagnosis that fit the symptoms better than Hugh-Stovin Syndrome? I think the only reason they picked it was because they needed a fatal disease.
January 12th, 2010 at 2:17 am
I’d love to see more episodes like this. I’m happy to deal with less-than-perfect medical stuff (since I have only a basic understanding of it to begin with) as long as it’s half as entertaining as this episode was.
January 12th, 2010 at 2:32 am
Once again, thanks for the review. I was getting a bit suspicious when the guy didn’t die almost immediately after the aeurysms burst.
The albuterol administration (that is actually a cool name now that I think of it) was also a bit weird to me as that’s the prescription I have for bad asthma (as though people are going to abuse it).
On a final note-you spend your spare time watching cataleptic goat videos?
January 12th, 2010 at 4:55 am
No mentions of the head to head tween Wilson and House over Kate from NCIS? That had me rolling (tho some of the stereotypical stuff – I’m straight but enjoy musicals). I thought for sure at the restaurant W was going to lean over and smooch H – the proposal was a great one up by W.
Chase’s haircut makes him look like a high school prep.
Did we get a deliberate mislead on the scene where Cuddy is talking to Foreman about leverage? I thought she had at the end she hadn’t seen him for 3 days?
January 12th, 2010 at 4:57 am
i was so dissappointed in this episode. maybe it was the long wait which made it such a let down.
January 12th, 2010 at 5:58 am
I must say that this is probably the worst episode so far, especialy after the “Wilson” episode but i must admit that House pretending that Wilsom and him being gay was pretty funny. I think the writers where acknowledging some of the stuff said over the internet about the two characters. The preview for the next shows really sparked my interest
January 12th, 2010 at 7:40 am
Regardless of the medicine in this one, it has to rank as an all-time great for the House-Wilson interactions. I laughed til I cried.
January 12th, 2010 at 7:58 am
The medicine was a joke but the rest of the show was hilarious. 6-foot The Chorus Line poster? ROFLCOPTER I didn’t think Wilson had it in him to propose in a restaurant.
I still don’t get how the diagnosis had anything to do with the gunshot/cane-slap that made him fall down…..? You know, the thing that led him to the hospital to begin with.
January 12th, 2010 at 8:01 am
Below average overall, but above average for this season. I was EXTREMELY relieved they didn’t go with a Wilson-House kiss.
January 12th, 2010 at 8:19 am
hey yeah, thats kate. cheers indiana dave, i knew i knew her, but not where from. it was driving me crazy. i kept thinking pru from charmed but knew it was wrong. the hair threw me. plus its been 5 seasons since kate was on ncis
what is a soft steroid?
when chase removed the first pulmonary aneurysm wouldn’t they have tested it? (or seen some sign of, or lack thereof, of fungal infection)
called the marriage proposal. thought they’d go with a kiss or something though. or house pretending to cry and saying yes yes of course
there was a solution to their problem of two men one woman. im surprised house didn’t suggest it
January 12th, 2010 at 9:01 am
@ Indiana Dave
AFAIK, they had the leverage meeting, then Foreman made up a second meeting that he told the rest of the team about in which he “bluffed Cuddy” with the “offer”.
January 12th, 2010 at 9:04 am
I’ll admit that my first aid is probably at least a good decade out of date (most of what I know now was learned from a first aid book sitting around the house that I was obsessed with as a child), but I’m guessing that the not putting something into the mouth has to do with a realization that they can’t swallow their tongues, but they might be able to bite a chunk out of whatever you stuck in their mouth?
January 12th, 2010 at 9:50 am
The medicine had to be bent a lot to fit around a rather complex story line about friendship and deception, maybe too complex for this show.
The cop’s drug partner thought of the cop as true and devoted pal. The cop knew this and yet still betrayed him. Was it because of devotion to duty? Was his friendship always a total deception? Was it because this was the only way to see his wife on his death bed?
House thought that through his usual deceptions he could manipulate Wilson and the situation to his advantage. It didn’t work but in the end it brought House and Wilson’s friendship to an even deeper (higher?) level. They’re clearly not gay but in the future how will House’s obsessive personality react with the free will of another human being. He can’t pop Wilson out of a bottle every time he needs a fix.
And the three colleagues, by pulling a joke on Foreman pulled themselves a little closer to each other but at the same time seemed to put themselves a little below Foreman in the Hospital Hierarchy.
Three stories about friendship in one episode were a bit too much for the medicine, imo. Cop/drug partner, Wilson/House, Underlings/Foreman and the deceptions that occurred among them left the medicine bending through the cracks between them.
January 12th, 2010 at 9:58 am
Anybody see the new Sherlock Holmes movie? The IMDB board has about 20 threads speculating whether Holmes and Watson are gay. I thought this episode was very timely as a super-Holmesian bit of House.
I thought the medicine kind of dragged. It’s disappointing that it was inaccurate as well as boring. Mickey and his drama was not boring–just the diagnoses and the casualness of the “oh, yeah, we had to remove a foot of his bowel” stuff. Probably the jargon didn’t help, either. Maybe they could have constructed a simpler diagnostic procedure to go with the more complex plotline.
January 12th, 2010 at 10:27 am
just like colin has said before: i have found no reference to sound-induced collapse in any of the hughes-stovin case reports. maybe its supposed to be caused by the beta-blockers.
any other idea?
ps: love your website. i read all your stories from medical school (when i was supposed to learn for an anatomy test) and i loved them. more please! :)
greetings from germany!
January 12th, 2010 at 10:49 am
I’m disappointed that Mickey Blue Eyes’ disease wasn’t one more common in or specific to blue-eyed people. (Assuming there is such a disease.) Especially after I went through the (minor) effort to see what colour his eyes were after we learned his name was Mickey.
I’m not qualitfied to judge the medicine (thus the above comment), but I thought the House-Wilson duel was excellent.
And I was disappointed that House’s eureka moment when talking with the neighbour in his office wasn’t spelled out better… or at all as our host at this site didn’t see a link between the conversation and the eureka moment either.
January 12th, 2010 at 11:24 am
The gay proposal – how Housian of Wilson. Well played, sir.
January 12th, 2010 at 11:25 am
Liked the soap opera, but disappointed the medicine was so wrong.
i shouldn’t suggest this, as I have no medical training, but could the collected intellects on this board suggest a medical mystery that is both interesting and medically sound? The show writers seem to need one!
January 12th, 2010 at 11:51 am
I’m with zimbabwe. The pun reference went well over my head. Maybe if I had actually seen the movie…
Say what you will about Wilson, but House is right. He is definitely not boring.
January 12th, 2010 at 1:27 pm
Does the overuse of beta-blockers actually explain the presenting symptom of loud-noise induced vertigo??
January 12th, 2010 at 3:48 pm
This episode was so much fun especially the gay part that I had trouble following the POW. The only thing I was sure was that it was not “environmental” – too much of a red herring to be truth. The part of the medicine that I actually managed to understand was the part with the beta blockers (this episode is still without translation so I’ll have to re watch it to pick up loose ends). Now I am not that familiar with the protocol for high BP tretment (it is a big and complex gray matter and considering that 7out of 10 people above 40 die from cardiac complications as a direct result from high BP or tachicardia, one should tread lightly there) but I am pretty sure that beta blockers are not used for stress treatment – so House was correct to call it of but he was incorrect for waiting a day for calling it off. No sane doctor would prescribe blood pressure pills to a nervous patient – he will try to correct the stress level first and than check and correct the BP. So this I suppose is a blunder for House and his team (they should have picked it up right away). Apart from this it was a hilarious episode so I’m happy House is back. And Huddy is temporarily out of the picture – a good thing cause it was too much drama for a show that is mostly about one person – not a chick flick after all! And RSL is getting more and more attention – good thing too. He is a bit overlooked for a great char!
January 12th, 2010 at 4:27 pm
Andrew in Toronto:
House was starting to say that Wilson looks like a proper Boy Scout, but really is a heartbreaker/idiot/jerk/whatever. Then he realized that the aneurysms look like fungus, but really are this Hughes-Stovin stuff (in case you can’t tell, IANAD).
January 12th, 2010 at 4:44 pm
I guess the ‘vertigo’ he refers to simply means that he drops to the floor (i.e. lowers in height), and not that he is dizzy or whatever vertigo symptoms are.
January 12th, 2010 at 5:09 pm
One thing I liked better than in previous episodes: they didn’t immediately throw all kinds of treatments at Mickey; instead they did a bunch of tests. Also, they didn’t have one doctor after the other traipse through his room to tell him yet another wrong diagnosis – they kept it within the team. I’m not familiar with the disease so can’t judge that part, but it was a bit more believable because of that.
I thought the “gay” part was well done. Yes, there were some stereotypes, but they stayed away from silly overacting, which made it very funny.
January 12th, 2010 at 6:32 pm
D-r Bulgaria:
The beta blockers are used by nervous people who need to look like they’re not nervous. By suppressing the natural adrenaline response to a stressful situation, they allow the patient to avoid elevated pulse, respiration and sweating. The cop needed to look like he was an experienced, cool criminal and to keep his wits about him while under pressure.
January 12th, 2010 at 7:06 pm
One of the most content-full episodes ever, with awesome funny moments. And yes, very Holmes like, the all gay proposal thing, and the ending.
January 12th, 2010 at 7:20 pm
For a moment i really thought the two gangstas would be gay, and that it would in some way be the end solution. Too bad… I really enjoyed the episode. I think the social inteligence is what makes me love this show.
Thanks for the reviews!
January 12th, 2010 at 8:47 pm
What was that spectacular bit of guitar music they played while Mickey was dying? It was quite uncharacteristic, but tremendous.
I thought the soap opera more than redeemed the episode, regardless of how egregious the medical errors may have been.
January 12th, 2010 at 11:41 pm
Something I liked about this ep was how the cop, who had betrayed the people who trusted and cared for him (criminals though they may be), ended up with a fatal and incurable disease. It reminded me of something they used to do in old episodes of Gunsmoke (and many other shows as well, i’m sure). Whenever a character killed someone or indirectly caused their death, but not in a way that would get them arrested, you could bet that by the end of the episode they’d get killed by some accident or other misfortune. Every single time.
January 12th, 2010 at 11:45 pm
I’m still missing how the noise-induced vertigo/cataplexy/whatever was associated with the final diagnosis. I thought Hughes-Stovin was primarily Pulmonary.
Also, surprised no mention of face masks when dealing with a potentially infectious patient coughing up blood, esp (if memory serves) this was how Cameron got the HIV scare a while back and mentions in previous reviews.
Regardless, thanks as always for the Fringe and House reviews.
January 12th, 2010 at 11:54 pm
@zimbabwe, I believe the movie reference in question is one of the best lines in that movie: “I can’t feel my legs! I HAVE NO LEGS!” Absolutely a movie worth watching. :)
January 13th, 2010 at 12:00 am
@ George Fowler:
Said by Ross
January 11th, 2010 at 11:25 pm
I liked Maggot Brain towards the end of the episode.
http://www.youtube.com/watch?v=dh3bleXWaCk
A most excellent bit of Blues from Maggot Brain and totally in character for Hugh Laurie… :D
January 13th, 2010 at 1:52 am
Okay, I can understand all the medical nitpicking by those who know better… I’m a musician and I can get equally bent out of shape when musical details in a general-interest show or movie are all wrong… but in terms of drama, comedy and wit, was this not up there among the best House episodes ever? From a dramatic perspective, this was a thoroughly enjoyable and entertaining episode, with no dead spots anywhere. I loved it.
January 13th, 2010 at 2:39 am
As a Neurologist, I have to say that despite the insane and at times nonsensical medicine “practiced” on the House, this is my still favorite show on TV. Most of the cases brought up involve the nervous system, either directly or as collateral damage, and the discussion, while at times way off base medically, are very entertaining. While the medicine on this show is of course not correct in most instances, I do love that the try more than any other show I have seen. The seizure portion was a bit much. I have to say that from a medical point of view, I completely agree with the above review and assessment.
January 13th, 2010 at 3:11 am
I liked the episode well enough; but I have a question that rather makes it obvious that I’m not a doctor… what was wrong with Foreman’s stuffing something in the mouth of a seizing patient?
Oh yeah, but I couldn’t help but think of the phrase I heard somewhere “Snitches get stitches” while the whole episode the “snitch” had prominent stitches on his forehead.
January 13th, 2010 at 5:49 am
Sam I absolutely agree with the idea to use beta blockers to supress symptoms of stress. What I do not get is House did not call the guy a lier immediatly – he said he was taking them because he was feeling guilty and stressed from his deeds – then a day later House said if you neede anti stress meds you would take meds that help relieve stress not the symptoms of stress. It was actually a good mini plot here just did not seemed believable for House – he is usually way quicker in dismissing misuse of meds.
January 13th, 2010 at 5:51 am
THe previous post is mine btw – I am at work and forgot to type my name…
January 13th, 2010 at 8:41 am
Thanks, muzz at January 12th, 2010 at 4:27 pm
I just reviewed my recording of the episode, and finally saw that House’s moment came in saying that Wilson looks like a Boy Scout but is as much of a jerk as House himself is, leading to the moment with House realizing that “the aneurysms look like fungus, but really are this Hughes-Stovin stuff.”
Maybe next time I’ll watch it twice or not exercise while I’m watching the programme the first time. :^)
And in retrospect, I enjoyed the personality duel so much, that I saved all of the House-Wilson-neighbour interactions on disc as a mini-episode.
January 13th, 2010 at 9:01 am
I have high blood pressure and my cardiologist has been adjusting my meds. A month ago I got up from the couch to go to the kitchen and after a moment’s dizziness found myself on the floor, having cracked my tail vertebra on a corner of the coffee table. Pulmonary problems can absolutely cause sudden fainting spells, which can mimic fainting from other causes like vertigo.
January 13th, 2010 at 10:10 am
I’m have no medical background, so help me. Why not put something in the mouth of someone seizing (in attempts to prevent them from swallowing their tongue, I assume)?
My guess is that the jaw is too strong, or it is pointless to do it. So what technique is used to prevent someone who is seizing from swallowing their tongue (or does it just not happen)?
I only ask for personal knowledge… not trying to be difficult or anything :)
January 13th, 2010 at 11:23 am
I think this episode, drama-wise, if not medically speaking, was on par with earlier sesons. It’s good to see a season that didn’t start up too well starting to catch up. Very entertaining, the House/Wilson-thing.
January 13th, 2010 at 2:12 pm
@Joseph Fischer
What you experienced is called orthostatic hypotension, which basically means that the body can not adjust fast enough to changes in body position. In the case of House’s patient the situation is different.
Maybe we should focus less on the loud sound part of his fainting attacks and more on the fact of sudden arousal.
January 13th, 2010 at 2:47 pm
I thought Jennifer Morrison was gone for good? Chase mentioned “the divorce” once or twice, and I remember late last year someone citing a magazine article that said she would be leaving the show in November. But the “pastoral river” slide with her name was still in the opening credits. Think maybe the producers just haven’t gotten around to updating the opening yet?
January 13th, 2010 at 3:47 pm
@Marotti:
According to two different sites that came up when I googled “seizure first aid”, there is no risk of the tongue being swallowed and both therefore state to not place any objects or fingers in the mouth. I had always thought that the precaution had as much to do with preventing them from biting their tongue and/or doing damage to their jaw from clenched teeth, but with human jaw strength high as it is (it’s actually pretty good if not on Doberman level), I could see potential risks in them biting through whatever’s placed in their mouth (including fingers, presumably) and then choking on that.
January 13th, 2010 at 5:27 pm
my fave line: “Did Cameron get your hair in the divorce?”
January 13th, 2010 at 5:34 pm
Regarding MVT, just following the logic of writers maybe
1. they could just changed mesenteric venous thrombosis to mesenteric artery thrombosis – well – who cares thats just vessels… and btw artery sounds cool.. or
2. it was written here regarding Hughes-Stovin Syndrome “Some authors consider this entity an incomplete form of Behcet’s disease….” and here you can find case of Behcet’s disease with mesenteric arterial thrombosis…….
January 13th, 2010 at 7:01 pm
Who cares about the medicine. Most of us don’t understand it anyway. If they wanted to make series that have realistic medicine they could easily do it, and series would be canceled after 2 episodes because even doctors wouldn’t watch it, because they don’t need to be reminded of they job while trying to relax.
January 13th, 2010 at 8:05 pm
I had a harder time not making any Empire Record jabs.
SHOPLIFTTTERRRRRRRR.
January 13th, 2010 at 8:33 pm
@ Petrovic: I would assume (the blog being medically oriented), that most of us who comment here ARE interested in the medicine. I also suspect that we would not be getting these wonderful reviews from Scott, and the great and often illuminating or hysterically funny comments from others were this not a medical show. Thank you again Scott and others for the constant entertainment!! I am always interested in the mistakes pointed out in the comic books by Scott.
Please correct me if there are any glaring mistakes here, but as far as the “vertigo” goes (bearing in mind that I cannot watch the show for another week): vertigo is a special type of dizziness, associated with certain clinical signs. It may or may not cause loss of consciousness (I have had vertigo and have not lost consciousness). But at any rate, it does involve dizziness. Syncope is loss of consciousness due to a sudden drop in blood pressure (normally called fainting) and cataplexy is loss of motor control (collapse) without loss of consciousness. There may be other conditions that cause collapse as well which I am missing. So when I was in vet school and later practiced, we did a variety of simple tests to determine whether the animal was experiencing vertigo or another cause of collapse. It would seem to me that if nystagmus wasn’t present after a loud noise dropped the patient and the patient did not complain of dizziness, then it probably wasn’t vertigo. Would this not be correct?
I think what I am trying to get at here is that these are all somewhat precise medical terms?
January 13th, 2010 at 8:39 pm
When Wilson asks the cute lady in 2b about the local dry cleaners she tells him to go to EcoClean two blocks down. Towards the end of the episode the team discovers the drug dealers are running an eco-friendly dry cleaning service.
So the inference I’m getting is a major drug bust occurred two blocks from House and Wilson’s apartment. Funny.
January 13th, 2010 at 8:52 pm
It was interesting that they had an episode where the end medical solution was “we lost before the game even started” (which has happened before) but the episode itself was on the whole pretty light and comical. I loved the subplot with House and Wilson and Sasha Alexander (NCIS never should have killed her off). The paycheck thing with the four underlings felt like ground that has been trod in the past, repeatedly.
And I thought Cameron had been written out of the series entirely. Why then are Jennifer Morrison’s name and image still in the opening credits? I suppose it’s the same reason Peter Jacobson, Kal Penn, and Olivia Wilde were never added to it, but it just seems so lazy.
January 14th, 2010 at 1:52 am
Andrew…
“And I was disappointed that House’s eureka moment when talking with the neighbour in his office wasn’t spelled out better… or at all as our host at this site didn’t see a link between the conversation and the eureka moment either.”
House started to say “…sure he looks like a boy scout”, contrasting this to the fact that Wilson was married 3 times and slept with a dying patient… as if to say “Things aren’t always what they seem”. (Playing with the overall theme of deception)
Which leads to the eureka moment. House figured out that what looked to Chase like mycotic aneurysms were really inflammatory aneurysms. They weren’t what they appeared to be.
January 14th, 2010 at 1:53 am
Sorry… didn’t see that muzz already answered you.
January 14th, 2010 at 11:30 am
1. Beta-blockers do cause rebound hypertension, but only in patients who take them for hypertension. If you use them to reduce the effects of stress, not gonna happen.
2. Beta blockers just slow stress induced tachycardia, don´t block it completely.
3. I think this wasn´t the first time they said “not autoimmune” and diagnosed an autoimmune condition.
4. Loved House and Wilson scenes with Nora. LOL!!!
January 15th, 2010 at 8:45 am
apparently i need to watch this show!
January 16th, 2010 at 11:49 am
House finally comes to terms with the dramatic view of life.
January 17th, 2010 at 7:10 am
“Why then are Jennifer Morrison’s name and image still in the opening credits?”
The contract for a given actor specifies where their name belongs in the credits for a series. In the case of a ’series regular’, their name is usually required to be there for the entire season.
Getting a variation on that generally requires forking over additional money to said actor.
That is actually one of the reasons why most shows only do cast changes between seasons.
There are many exceptions of course.
January 17th, 2010 at 8:23 am
[...] See also: Medical Review of “The Down Low” [...]
January 17th, 2010 at 10:05 am
OK – I can’t argue the medicine, probably nowhere as good as others (like the heavy metal toxicity poisoning episode but all the tests came back negative)
HOWEVER
Can I say the show is coming back in terms of its dramatic flare? Something that had been a bit shaky this season. It was great to see the characters screwing around with each other again in a battle of wits, especially House and Wilson. I miss House’s insanity; it seems Cuddy never stops him anymore from his risky methods — perhaps side effects of a softer House after rehab? Writers, we need a TINY bit back. I miss the House that shoots a deceased patient or gives a coma patient a migraine.
Can I also mention how awesome Thirteen is. Does anybody other than me think her actions suggest a very interesting past? Observations include:
A) Remember the episode where her and Taub buy drugs and she knows exactly how to get. and what not to get (the “stuff” for new clients vs the “stuff” for established clients).
B) There is the episode where the painter tries to make out with her and she doesn’t hesitate to punch the guy. Very decent hook if I remember correctly?
C) This episode, she seemed pretty quick on her feet to pose as a prostitute and was convincing.
For these reasons, I’m thinking she knows “street life” pretty well and I’d love to know more on the how/why. But alas, Thirteen hides everything (even just the fact that she uses an asthma inhaler…)
January 17th, 2010 at 5:47 pm
Loved, loved, loved the House/Wilson scenes and Nora in 3B. The rest of it was smelly garbage.
January 17th, 2010 at 5:52 pm
Why then are Jennifer Morrison’s name and image still in the opening credits? I suppose it’s the same reason Peter Jacobson, Kal Penn, and Olivia Wilde were never added to it, but it just seems so lazy.
I think that sort of thing happens because of actors’ union rules about credits and seniority; and whatever personalized contracts the actors have with the production.
And I’m not interested in the medicine per se, either, but I do enjoy reading the medical background material here and reading others’ opinions about the show and/or episode even though I could never guess at a credible solution myself in a thousand years.
I originally found the site after I mentioned on another, unrelated forum that I had missed the last 10 minutes of an episode and was disappointed in missing the solution. Another poster suggested looking here, and I’ve visited the site ever since.
[Thanks, Mike. It's the thought that counts.]
January 17th, 2010 at 6:17 pm
I see some people mentioned as a minor complaint that the gay comedy involved too many stereotypes, but I actually think that was the point — Nora jumped to the conclusion that they were gay just because they were male roommates, so it seemed that stereotypes would work perfectly in deceiving her.
I enjoy the chemistry between them a lot, but I still believe “Hilson” would be a bad idea — they are the Odd Couple, or Joey and Chandler if you like; for me, a romantic relationship would ruin the most touching thing about them: it’s not actually chemical, it’s not a basic instinct that drives them together, nor is it based on a family tie or a childhood bond, this is a friendship that they built from scratch as independent adults. Admittedly, it needs a lot of maintenance work :)
On a medical note: for sure it’s a dramatic device — albeit rather overused — on the show, but how often do violent seizures really happen during a medical test?
January 18th, 2010 at 4:06 pm
I did not catch it the first time I heard it on the show but reading this:
“Chase is sporting a new haircut (to which House asks if Cameron “got [his] hair in the divorce”)…..”
had me chuckling for some time. Thanks Monsters of Television.
January 19th, 2010 at 12:30 am
I’m way too late for this but I just saw the episode and I loved the interrogation scene
January 19th, 2010 at 5:09 pm
both the patient and the medicine were pretty boring–overall, the show used to do a better job in its earlier years with not just making the medical mystery more compelling (if not more accurate) but with producing interesting patients so that we got interested in the story.
That said, the side stories of House/Wilson and the team/paychecks were hilarious. Cleverly done..a bit of that old House bite.
January 20th, 2010 at 3:57 pm
My dad has had tonic-clonic (grand mal) seizures since he was a child, so allow me to impart a little wisdom. A person in a seizure may clamp down, biting and then inhaling pieces of something in his mouth. Also, during clamping down, teeth may break, which can be inhaled. A person may bite down on his tongue (which bleeds quite a bit) and then choke on the blood. There are specially made mouthpieces for epileptics; but otherwise, the patient should be lain on their side to allow vomit and drool to fall out. Also, do not hold down someone in a seizure, you’ll get yourself hurt. Put something under the patient’s head to keep him from banging his head on the floor.
January 20th, 2010 at 4:23 pm
Not sure if this was stated already, but Cameron is coming back this season (and next), and starting next season both 13 and Taub will be in the opening credits finally…just in case anyone isn’t up on their entertainment news. I can’t wait (no pun intended for Scott) to see Cameron back again!! :)
January 25th, 2010 at 10:56 pm
Miss January,
What evidence do you to assert this? Is there an official release?
February 1st, 2010 at 6:10 am
more of soap drama and pathetic medical drama…..
February 5th, 2010 at 1:23 am
Did anyone else catch the feeling that the real gangster had a secret gay love for the informant? I thought that was an obvious parallel with the fake gay relationship between House and Wilson.
February 7th, 2010 at 4:57 pm
I must disagree with you, D-r Bulgaria…someone tried to do that to me recently. She got very angry when I would not take the drug, but she wasn’t insane. :)
As a veteran i go to the VA here for healthcare and recently my “primary care provider” tried to put me on an anti-hypertension medication without monitoring it or evaluating my health status at all (the VA has refused to even do a complete physical exam for 3 years). To complicate matters further I am disabled with Post Traumatic Stress Disorder and had had to wait for my appointment in a crowded area where I did not feel safe, so my blood pressure had spiked. I am unsure if part of the problem is that I have no access to a medical doctor…my “provider” is a nurse practitioner.
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