House — Episode 14 (Season 6): “Private Lives”
The set-up was clever, but the medicine and final solution were sloppy and average, at best. The speed dating scene was worth it, though
Frankie is a 28 year old vegetarian (well, mostly vegetarian) who presents with a sudden case of severe coagulopathy (blood that won’t clot correctly — in Frankie’s case, her symptoms included facial bruising and bleeding gums). The initial thoughts include a congential thrombocytopenia (an inherited condition of low platelets), a toxic exposure, or a deficiency in clotting factors. House thinks the toxin exposure is the best option, and has the team search her apartment. Nothing is found in the search, but a conversation with a neighbor indicates that she has been exposed to rat poison (this is important because a common kind of rat poison is an anticoagulant and would explain her bleeding problem). Soon, Frankie complains of “muddy” urine, which the team takes to be a sign of kidney failure, meaning that rat poison was not the cause.
Looking at conditions which cause both a coagulopathy and kidney disease, the differential now includes hemolytic-uremic syndrome, Gaucher’s disease, Sjogrens syndrome (an autoimmune disease), and Haff disease (sudden development of rhabdomyolysis shortly after eating fish, thought to be related to some form of toxin). The latter seems the most likely and she is started on saline and mannitol (the suggested treatment for Haff disease is fluid and diuretics so these are reasonable choices). Chase still believes his suggestion of Sjogrens was the best, and reads over Frankie’s blog looking for clues. He sees one post mentioning decreased sexual arousal and he suspects this is due to vaginal dryness, a sign of Sjogrens. He wheels her into the x-ray suite to perform a sialogram (an x-ray of the salivary glands, because decreased saliva production is another sign of Sjogrens). He is unable to get the x-ray because she complains that it is uncomfortable to lie down. Chase recognizes this as a sign of valvular heart disease, and sure enough, an echocardiogram reveals severe problems with an unspecified mitral valve disorder (probably mitral valve regurgitation, as this has been associated with Sjogrens). Her condition is so bad that she will need an artificial mitral valve.
As she is being readied for surgery, Frankie develops severe right lower abdominal pain and vomiting. Emergency abdominal surgery reveals a burst appendix. Even worse, studies suggest that the appendix burst because it was full of cancerous cells — lymphoma — that has now spread throughout the body. The team tells her that it is too late for regular chemotherapy, but that she is a candidate for an experimental anti-lymphoma vaccine. Without it, she has maybe a year to live. She agrees and is started on the vaccinations. Everything goes well at first, but after the third dose she suffers a high fever. The suspicion is that the vaccine has triggered a severe immune response of some sort.
During a discussion of the case with Cuddy, the fact that Frankie is a night owl comes up in conversation because this is new for her. Until six months ago, she was up during the day instead of at night. According to the team, day-night reversal can be a sign of liver disease (true, to a point). A liver biopsy confirms that she has liver failure. What was initially thought to be lymphoma is now recognized as a granulomatous build up (inflammatory cells) related to the liver failure. Instead of a year to live, she is now given a few days.
Looking over her symptoms of fever, cell atypia, coagulopathy, liver disease, kidney disease, and heart disease, the team suspects some form of infection but can’t narrow it down any more than that (I don’t buy it: something inflammatory like an autoimmune disease could explain all the symptoms just as well). House orders her started on broad spectrum antibiotics. A later conversation with Wilson leads to his Eureka! moment. He realizes that in all her blogging, even the intensely personal stuff, she never mentioned her bowel movements. Direct questioning reveals that she had a change in bowel habits consistent with a malabsorption syndrome — in this case Whipple’s disease. A course of antibiotics and she’ll be fine (though she’ll still need the new mitral valve).
As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:
The writers don’t seem to understand kidney failure. It is – just as the name suggests – a failure of kidneys – that is: they don’t work any more. Instead of normal urine production there is a decreased or absent urine production. Dark urine is not a sign of kidney failure.
Dark urine is a common sign of a bleeding disorder, just like Frankie has. It would be more proof of rat poison exposure, not less.
Her kidney labs are normal, at least the creatinine is (arguably the most significant one), so she has no actual signs of kidney failure.
How did they miss severe liver failure on this patient? Liver labs should be drawn for every patient with an undiagnosed clotting problem,and it should have shown up on her other tests as well.
I don’t buy the whole “the lymphoma is too advanced for chemotherapy” argument. What tests have they done to show how widespread the cancer is? What treatments have they tried and failed?
The vaccine only works for follicular lymphoma, a rare type, and it doesn’t cure it, it just extends the time until the inevitable relapse this type of lymphoma always has.
Frankie has severe enough mitral valve disease to require a new valve sooner rather than later, yet no one heard a murmur on exam?
Other than a possible Vitamin K deficiency, what other signs of severe malabsorption does she show? None. Where’s the long history of weight loss (no way she wouldn’t have mentioned that on her blog), joint pain, fatigue, and fever?
Day night reversal is a sign of severe hepatic encephalopathy, which is seen is severe liver failure.
Her bleeding and bruising came on incredibly fast. I wouldn’t call it impossible, just very very very unlikely.
I find it sloppy work that no one asked about her bowel movements until House finally did. (It’s one of my “big four” questions I ask every patient). Especially in a patient they were considered hemolytic-uremic syndrome in.
If the team ever did a thorough admission exam and history, these shows would be lucky to last a half hour. How many diagnoses have they missed because of sloppy exam or poor history?
Another interesting medical mystery — better than most this season. It earns a B+. The final solution was a stretch. If her Whipple’s (and liver and kidney) had really been that bad, there would have been many signs along the way. I give it a C. The medicine had lots of holes this week, and the parts didn’t add up. It deserves no more than a C-. The soap opera was good. It was nice to a non-melancholy Chase again, and the House/Wilson scenes were well down. The speed dating was terrifically over the top. The soap opera earns a swofting A.
The review of the previous episode of House
A list of all prior House reviews
March 8th, 2010 at 10:37 pm
I had the thought as well about the dark urine being a sign of blood in it, going along with the rat poison scenario.
I had figured that whatever she had was going to go back to the whitewater rafting 6 months ago, possibly what almost killed off Foreman back in season 2.
Scott, I am curious though as to what the big 4 questions you always ask are.
March 8th, 2010 at 10:46 pm
Official Comment
I learned these from one of my attendings during my fourth year sub-internship in Family Practice and have found them very useful since:
1. Sleeping OK?
2. Appetite OK?
3. Any bowel problems or changes?
4. Any urinary problems or changes?
(i.e. sleeping, eating, peeing, pooping. You do OK on these, and you’re doing pretty well overall).
March 8th, 2010 at 11:12 pm
I have a feeling Chase and 13 will be hooking up sometime this season.
March 8th, 2010 at 11:53 pm
Loved the House/Wilson scenes. And Chase trying an American accent.
How would liver failure cause the day/night switch? Just curious.
March 9th, 2010 at 12:00 am
@Robert – Chadley (you heard it here first) is one of the only things I can think of that would knock me out of this show. Obviously the #1 thing would be House actually finding happiness in someone… Wow that’s sad when I write it out like that.
March 9th, 2010 at 12:47 am
I have Lupus/AutoImmune Hep, Early Cirrhosis, Sjogrens syndrome, + and have had SEVERE sleep problems for 5 yrs. Always tired, but can’t sleep. Have all the mental insufficiencies of Sleep Deprivation to go with it! Previously my sleep was interrupted by pain but Adjustable Temperpedic (believe it or not) solved that issue. I learned tonite that Day/Night Reversal was a symptom of liver disease. I’m curious how the liver affects Circadian Rhythm also? Oddly, I am consistently awakened @ 3am every night and cannot fall back to sleep until 6am – doesn’t matter if I went to bed @ 9pm or 2am. Since this is a crucial time for the body to transition from melatonin production to cortisol, adrenaline, and seratonin production this could be a major influence on why my immune system is so screwed up? Yea, this is probably TMI but appreciate any info, love the show, and your analysis. Bookmarked site!
March 9th, 2010 at 12:57 am
The second I saw Laura Prepon’s face I realised – DAMN, this is gonna be bad, because Laura Prepon can’t act to save her life…
March 9th, 2010 at 1:11 am
It was good to see Laura Prepon back on a Fox series but she’s Wayyyy better looking as a redhead.. ;)
The sub-story this week was pretty interesting, it was cool to see a side of House that he doesn’t let come out to play very often and the whole “will he meet his daddy or won’t he” will add some grist for Wilson to hopefully prod him in to doing what he wants to deep down in side but is afraid to.
Was it me or did it seem like there really WAS some sexual tension between Remy & Robert? She turned him down but she WAS smiling so….
Wilson starring in a porn… lol now THAT I didn’t expect and having movie posters made & hung in Wilson’s office wass ‘vintage’ House for sure..
I wish Fox would not try and spread the rest of the season out 1 episode every 2-3 weeks like they have recently….
And on a more somber note this season started off with a BANG but it seems to have somewhat ran out of steam as well as ideas… how many times are we REALLY going to see rhabdomyolysis offered as a diagnosis before enough is enough?
This episode reminded me of “Epic Fail” in that they both used internet postings as plot devices and a way to judge the conduct of the Doctors…..
There’s going to come a time of diminishing returns where the writers begin to rehash past plot elements to keep the show going b/c they run out of new ideas and it’s looking like after this season they may very well have hit that wall… I hope I’m wrong but….
March 9th, 2010 at 4:02 am
I thought it was a good episode, althought, i must say, sometimes the team not taking an actual decent history annoys me.
On the Dark Urine part though, I thought that one of the symptoms of renal failure was a lower then normal urine output, and the urine itself was dark in colour?
March 9th, 2010 at 4:15 am
Everyone who comes into that hospital seems to be diagnosed with kidney failure at some time or other. I’d say they’ve got the X-ray intensity on the security scanner turned up WAY too high.
March 9th, 2010 at 4:29 am
I dunno…House asked about her poo change from months ago, which she ascribed to changing to a vegetarian diet, so the non-brilliant doctors may have done the same.
If a doctor asked me “Any problems or changes” I don’t know if it would occur to me to mention changes from months ago unless he specified how far back to report. No doctor has ever asked me about poo texture, either.
March 9th, 2010 at 5:12 am
Chase and 13 hooking up? yeah, that’d be really great. Now all we’d need is Foreman and Cameron getting together and we’d be set *rolleyes*
March 9th, 2010 at 6:07 am
It was really difficult for me to follow medicine here because the non medical parts were absolutely hilarious :). House Wilson and my PF Chase – Funny, funny, funny! Wilson a pron star – fallen of my chair :) House reading cerements for whichever reason – nearly chocked. Anyway the medicine here was half decent at least considering it is season 6 and they tend to just trow insignificant discrepancies right overboard – such as the fact that Lymphoma is usually confirmed with more than a blown appendix quick look up. Here are my major complaints (about medicine):
1. Time course: For the 20th time let us get one thing straight – there is chronic liver failure, there is acute liver failure. Those two conditions develop at different rate and as such have a different array of symptoms. You cannot just mix and much whichever symptoms you like from both conditions. You also cannot expect for a liver failure that developed over 6 months to kill a person in 4 days – at least not with some other red flags showing first.
2. Kidney failure – our host explained what is wrong with that I’ll simply add that brown or tea colored urine is a sign of rabdomyolisis or sudden muscle death of any kind (like what House had when his leg infarcted – remember “Three stories”?
3. Whipple’s is actually a good choice of a mystery by the authors because it presents itself with very atypical symptoms – as a matter of fact only around 15-20 % of people with Whipple have the “major” symptoms of the disease. A doctor suspects Whipple’s and than confirms it with guess what! a biopsy of the intestines. So when they removed the appendix and they did a biopsy they should have seen the infiltrates that are consistent with Whipple not lymphoma. Of course if they did what D-r Scott suggested – get a good history, Whipple’s would have been one of their choices all along.
4. I am not sure about this cause it was long ago but how exactly Whipple’s can cause valve sthenosis? I am pretty sure it cannot.
The rest of the episode and the soap opera was truly great and reminded me of the best House moments we had. And since the time warp episode of Grey’s anatomy was such a plagiatism from two of the best House episodes (Three Stories and Honeymoon fused together – it almost made me puke!) I am trully happy that the show is still going strong and does not need to resort to low tricks to keep his audience. Unlike the ABC “star” drama this is the real deal. Go Brian Singer go FOX!!!
March 9th, 2010 at 6:11 am
Almost forgot – if they manage to hook up 13 and Chase – now that would make me puke and hate House. The conversations between those two in this episode were entertaining but I do not think they will lead to something; the turns and ending suggested a one episode deal not the beginning of a romance.
March 9th, 2010 at 6:53 am
Scott, was the valve choice dilemma accurate? Does a plastic valve being put in make having a baby not a good idea?
March 9th, 2010 at 7:14 am
Wouldn’t a sudden, severe onset of abdominal pain like Frankie had not be typical of appendicitis? (More likely a perforation of an ulcer or rupture of an aneurysm from what my textbook says). I always understood that the pain started centrally and moved to the right.
Of course, when they started talking about this massive release of cancer cells from the burst appendix I tuned out for a while, especially when as you pointed out, there was no indication of what type of lymphoma or what could be done to treat it other than an experimental protocol. But then again, House always generalises on cancer and its treatment unfortunately.
March 9th, 2010 at 7:35 am
I look forward for a romance between Chase and Thirteen. This will spice up the drama. Just think of the implications – Foreman is jealous, may be House too, because she is the only woman in this show not to fall for his diabolic charm, then Cameron comes back and things get even more complecated. And remember the first sparlke of romance between Cameron and Chase? That was in the “Occam’s Razor” (1st season) I think, when Chase tried to ask Cameron out and she didn’t let him finish the sentence and said: No! The same here: Chase asked Thirteen if he could borrow her car and she said: No! May be writeres hinted their intentioins this way.
Scott, thanks for the wonderful medical reviews. I have been reading them for a long time but I comment for the first. These reviews are the first thing that managed to make me less of a fanatic about House. :) I am not a doctor (but I greatly respect dotors and puzzle-solvers) I am a writer and a journalist and that makes me a puzzle-solver myself, although a different kind. I will educate from the medical stuff and comment on the drama. Nice site!
English is not my mother tongue, sorry if there are mistakes.
March 9th, 2010 at 7:44 am
love this site, enjoyed the episode, but my complaint is theological. I am pretty sure the bio-dad was described as a Unitarian minister. If that’s the case, the sermons would not be “god”y at all – UUs are all about the search for one’s own truth, not a superimposed god figure. Lots of aetheists are Unitarian Universalists, and certainly plenty of agnostics. So House would find some sense in his father’s point of view.
March 9th, 2010 at 7:52 am
Good point, Deegie! And thanks for it. More potential drama.
March 9th, 2010 at 8:14 am
Except, deegie, there’s a big difference between Unitarianism and. Unitarian Universalism. Unitarianism is still a Christian theology.
March 9th, 2010 at 8:38 am
If the team ever did a thorough admission exam and history, these shows would be lucky to last a half hour. How many diagnoses have they missed because of sloppy exam or poor history?
________________________________________
Seems to me this is a bit more than a nit-picking complaint; it gets to the heart of the matter for doctors and med students who are most interested in talking about the question of “did they get the medicine right?”
On the other hand, I’d be happy to see far less medicine (and more accurate, “realistic” medicine) if it meant more of the so-called “soap opera,” the interactions between these characters.
March 9th, 2010 at 8:59 am
Official Comment
Indiana Dave,
Yes, the valve replacement issues were accurate. Porcine (pig) valves don’t require blood thinners, but only last 10-15 years. Mechanical valves last a long, long time but they require blood thinners. The most common blood thinner Coumadin (warfarin), a daily pill, is not safe during pregnancy.
However, the patient could switch to Lovenox, which is a different type of blood thinner (this would require two subcutaneous injections daily for the duration of the pregnancy) which is safe.
March 9th, 2010 at 9:24 am
Dale, I’d be surprised if the script referred to small “u” unitarian thought, which would be a rather arcane theological reference. Unitarians dropped the trinity way back when; and at least one Unitarian church (All Souls in NYC doesn’t mention Jesus in the order of service at all). Point is – a non doctrinaire religion…deeds not creeds…and therefore not anathema to House.
March 9th, 2010 at 9:32 am
I enjoyed the back and forth between house and wilson but could not help but notice how contrived the initial salvo was. Wilson magically ends up in the intro for a porn film? That’s a bit too much of a stretch for me no matter how funny the consequences are.
March 9th, 2010 at 10:02 am
When House was talking about poo, he said that vegetarians, like rabbits, should have hard solid output. However, elephants, horses, cows, bison, and other plant eaters leave “patties” instead of “jelly beans.” I know that vegetarian people do not produce rabbit like “jelly beans” either. Maybe if a person ate just grass, hay, and some herbs, but even vegans also eat fruit, nuts, and beans. And vegetarians generally produce a nice “log.”
March 9th, 2010 at 12:52 pm
It seems out of character for House to hide his real intentions concerning his fathers book. Why would he rather be thought to have found religion than just admit he wants to know how his father thinks? If House openly reads the bible out of sheer curiosity, “studying” his father could easily have been understandable from the same perspective. It wouldn’t have made House seem like a hypocrite like hiding it did. That’s probably why everyone else were so content with House being secretly religious. Why else would he hide reading that stuff? Nobody assumed he had an ulterior motive because then he wouldn’t have been trying to keep it a secret. Why does something that wouldn’t come as a surprise to anyone else have to be hidden at the risk of being discovered and interpreted as something else, witch in turn is a lot more embarrassing than the truth?
Of course, from a writers point of view, there is a lot better story if House is hiding something. But when we all know that it can’t be anything actually embarrassing, because it would hurt the character too much, there is no way left to make the story believable.
March 9th, 2010 at 1:59 pm
Actually rabbit feces are more a product of the lagomorph GI system: their small intestines do not absorb nutrients well from the plant products they eat, therefor the nutrient-rich portion is shunted off to the cecum where it is fermented into an absorbable form called cecotropes, eliminated, and then re-ingested (I know how disgusting that sounds, but it is a very important part of rabbit nutrition) while the large fiber particles continue on and are eliminated as those neat little balls.
March 9th, 2010 at 2:47 pm
Why is there all the peremptory disgust at a Chase/13
coupling? Look, I know squat about medicine, but …
there was an episode in “Lost” where a character
asked another character, “You hitting that?”. At the
outrage response, she calmly explained, “She’s hot,
you’re hot. hot people hook up”.
You learned it in the 6th grade,
you had it rubbed in your face
every minute of the day in high school,
you depressingly (or exhilaratingly) had
it affirmed in in college and beyond:
hot people hook up.
It might be the most realistic biological event
that will ever happen in “House”.
March 9th, 2010 at 2:47 pm
All I know is that 8 out of 10 people reading Frankie’s blog are idiots who don’t know that fish are animals.
March 9th, 2010 at 3:37 pm
I thought it was a good episode overall, aside from the medicine. There’s a pattern to how the writers write: if the soap part is longer than the medicine parts, they were aiming to advance to show. If they’re about equal then they had a good idea, but it never advanced the show. If the medicine is longer than the soap, they had no ideas and pulled some rare, weird disease out of a pathology book and selected whatever symptoms they wanted, plus some more.
I think it would be interesting to see how the characters react if Chase and 13 got together. I figure Foreman would be jealous, but would deny it and rationalize it. House would mess with them (and Foreman, of course). Taub could care less and Wilson would probably try to stop House messing with them.
But, from what I see in the next coming episodes, it seems Wilson has a better chance with 13. Fits Wilson, too. She just got out of a relationship and she is sick. Seems like a double win for Wilson.
PS: Did anyone think that Foreman dating 13 was Oedipal? I mean, Foreman’s mom had Alzheimer’s and 13 has Huntington’s.
PPS: Did anyone ever realize that the medical specialties reflect the history of each character?
March 9th, 2010 at 4:21 pm
Dunno if anyone mentioned, but I think the House/Wilson scenes were well done, not down.
Since the Chase/Thirteen topic seems to be popular I’ll throw in my two cents.
I find it pretty unrealistic…Let’s face it. What just happened to Chase? He got dumped by a female doctor he worked with.
What just happened to Thirteen? She got dumped by a male doctor she works with.
If I was either one of them, I’d say lesson learned.
Though it is always possible the writers are just throwing us for a loop and leading us down blind alleys and they never will get together.
That said, I’m not totally against it.
March 9th, 2010 at 5:08 pm
The medicine might have been bad–would I really know?–but who cares when an episode as as entertaining as this one. It’s been a long time since I’ve gotten major guffaws out of a House episode. The patient was interesting (though the acting was sub-par for House), the case was interesting, the character interactions were livelier.
I would hope 13 and Chase do not become an item, simply because the soap of the soap opera has gotten so wearying. Someone’s always on the verge of dying, or starting a romantic relationship, or breaking it up. It works better when these are colleagues with complex, smart interactions, whether or not they even like each other.
I agree with whoever posted above about the dragged-out season. It doesn’t work. Too much lost momentum.
March 9th, 2010 at 6:27 pm
I think this might go down as one of my least favorite episodes ever. I did love the speed dating scene, but beyond that I hated every minuted. I hated Laura Prepon’s character (though I bet she was right at home on a show with a character named Eric Foreman). If my girlfriend didn’t know the meaning of the word “discretion,” we wouldn’t be together very long. I just wanted to reach through the TV and slap her upside the head when she got to “The reason people don’t mind behaving badly is there’s no record of what they do.” Actually, hon, there’s no record of what we do, so we can forgive and forget if someone does something wrong. And then, the whole solution was about poop – count me in that first group of people House was talking about who really don’t want to hear about it.
March 9th, 2010 at 6:28 pm
And I didn’t buy or get into “Wilson was in a porno” either.
March 9th, 2010 at 8:01 pm
What about Sjogren’s without Sjogren’s main sympton?
Does Sjogren can damage the mitral valve ? If it can, a strong sjogren to cause so damage like that would be seen asdry eyes and dry month, first?
March 9th, 2010 at 10:33 pm
“I wish Fox would not try and spread the rest of the season out 1 episode every 2-3 weeks like they have recently….”
They’ve only done it for this one episode, so that new episodes wouldn’t be wasted airing opposite the Winter Olympics on NBC. Any gaps between the immediately prior episode and the episodes previous to it are just the normal winter hiatus.
March 10th, 2010 at 1:25 am
And I didn’t buy or get into “Wilson was in a porno” either.
Truth be told, me neither, although I almost hit the floor when Thirteen deadpanned, “Be not afraid.”
I did find myself thinking: Was that actual footage of Robert Sean Leonard from way back when? (We all remember RSL in “Dead Poets Society,” don’t we?)
March 10th, 2010 at 4:06 am
all the people here talking about Cameron “coming back”….they already said she’s shot her last episode.And that was before the New Year.
March 10th, 2010 at 5:13 am
@ anon “…but the also said she might be back for a guest appearence!” Actually my money is on that exactly. However I am still against Chase (my PF as I said multiple times) and 13 (my least favored also said a lot of times) to hook up. It would make sence in the way “they are hot” but non in any other way. May be some casual sex? A lot more in character for 13 anyway (boy I hate that chick!). As for funny – sure it could give material for a couple of episodes but otherwise it is a “jump the shark” moment and it would lower the show to the grade of Grey’s anatomy – my least favorite medical drama this last days. Let us hope for some good fashion creative thinking from the producers and not to go in that direction. Now let me jibble with the female audience (since I’m a dude and not objective :) and start a mini poll here;
Is D-r Chase really that good looking:
A) Yes
B) Oh Yeaaahhhh
C) No
D) He’s OK but nothing out of the ordinary
E) Don’t mind if I do :)
Vote female readers :):):)
March 10th, 2010 at 7:48 am
The Wilson porno stuff reminded me of Robert Sean Leonard playing Puck in Dead Poets Society.
And as long as folks are playing “Have you ever noticed?”… RSL was in Dead Poets Society where Kurtwood Smith played his dad. Kurtwood Smith was Eric Foreman’s dad on That 70’s Show, and did an appearance on House. Now Laura Prepon shows up… Plus, in a sidebar, House has featured both Harold and Kumar… I’m convinced this all links up in some interesting way, but it’s beyond me how…
Anyway, this was the first time EVER that Chase caught my interest as a character.
March 10th, 2010 at 8:38 am
As always, IANA MD, but wouldn’t severe liver failure give the patient severe Jaundice? Even without the labs, wouldn’t she be noticeably yellow from the minute she was admitted??
March 10th, 2010 at 11:41 am
Just wanted to clarify in defense of Wilson :)
He filmed a movie in college for a friend, but the porno part was filmed with a different actor that looked (remarkably) like Wilson. The pieces were spliced together to make the porno, so Wilson was completely innocent :)
March 10th, 2010 at 11:43 am
also, I find it disappointing that brown urine does not mean kidney failure! I’ve watched House from Episode 1 and the writers have trained me to know (haha) that peeing blood or brown means kidney failure, vomiting blood or an enormous bruise on the right side means liver failure, and if someone says they have to use the bathroom, it pretty much guarantees that when they stand up or roll over there will be a puddle of blood on the bed :-P
And I thought I was so close to being a real doctor.
March 10th, 2010 at 12:06 pm
No house episode is complete without this review :D!
March 10th, 2010 at 12:19 pm
I was kind of relieved that the patient wasn’t able to have her x-ray or scan or whatever–I was bracing for some kind of dramatic seizure or attack. It was kind of pleasant to have the “seizure” turn out to be inability to lie comfortably flat on her back, and the next crisis to be mere appendicitis (even if it was a version that gave her a year to live, or a few days to live, or whatever).
My husband just had an appendectomy, and one does not recover from it in a few hours ready to blog–or talk to the doctor about cancer options. Lots of pain and pain meds, pt to get you walking so your gut will remember what to do, etc. She had plenty of reasons besides “denial” not to be able to respond to a new problem.
A friend of mine one explained to me that “A Unitarian is someone who believes that there is at most one God.” The Unitarians I have known have been pretty much agnostic to atheistic, though Christian in the sense of admiring the Gospels and celebrating Christmas and Easter and holding services on Sunday. Anyway, a Unitarian minister’s audience would probably not be looking for God-stuff with underlying God-stuff, but for positivist ethics.
I really would like to know where the antler-boy footage came from. It was great.
March 10th, 2010 at 12:33 pm
To those wondering why Wilson was in a porno – he wasn’t. He did a few shots for a friend’s video that the friend later edited into a porno. That’s why he kept saying “it’s not me”. I think it’s completely realistic – I did a lot of that goofy stuff for my friends in high school/college that were “film majors” and it’s not that much of a leap to think that it could be re-edited elsewhere.
As for Chase – don’t mind if I do! Personality-wise I think he’d be a fun & interesting person to spend time with, although he’s too damaged for a long-term relationship (divorced after a short marriage, daddy issues, etc).
And I loved the stab at psuedo-vegetarians. I know too many people who don’t think that fish count as animals and I love to call them out on it, especially since I’m a marine biologist.
Thanks Scott – I’ve been reading these for the past 3 seasons but it’s my first time posting.
March 10th, 2010 at 12:46 pm
Sjogren and coagulopathy???
March 10th, 2010 at 2:17 pm
Casting my vote: Oh yeah! (I hate that he’s so broody these days) He would be interesting to hang with, I agree-the bet at speed dating was hilarious!
March 10th, 2010 at 7:36 pm
Scott
I find it interesting that your 4 big questions are the same ones that Vets will ask owners when they take their pets in for a visit.
March 10th, 2010 at 8:14 pm
@Landman: “It seems out of character for House to hide his real intentions concerning his fathers book.”
Not really: he probably didn’t want Wilson harping on him about the need to connect with his father (understandably, since it seemed to push Wilson’s lecture button especially hard).
I’m really curious to know if the “porno” was footage of a young and unknown RSL. I can’t decide what would be funnier, that old footage actually existing or RSL wearing furs and darting around trees just for this episode.
Frankie was, technically speaking, a pescetarian. Not a vegetarian.
March 11th, 2010 at 9:58 am
IANAD and I watch House for the character interactions, creative set-ups, sophisticated dialogue, and fast pacing. I enjoy the medical overlay as interesting gobledegook and only occasionally notice mistakes obvious to a layman. I do often wonder if I’ve been led down the primrose path and sought out this blog to confirm my suspicions. What a find! Medical terms come at me so fast I can’t remember most of them, let alone follow their logic. I doubt most viewers can–even most physicians. There are too many distractions, misdirections, and multiple possibilities. Dr. Scott is an amazing diagnostician in his own right to be able to do it so minutely, thoroughly, and quickly. I wonder if he has an idetic memory? He seems way too knowledgable for a GP/Family Practice nonspecialist. I also appreciate the high level of most of the other posters–including the English-challenged ones. Clearly this blog has an influence on the writers of the show. I can sense them trying to respond to the more prominent and persistent critiques aired here. Good Show Scott and Good Show Brian!
March 11th, 2010 at 6:58 pm
I’m sorry to notice that they don’t have a decent medical consultant in the writting team. Even a general doctor should be more careful, not a top diagnostic team.
A lot of signs and symptoms are far fetched for the final solution. All that race against major organ failures and certain death is, in the end, very boring and annoying. I’m also tired of the certain (but proving wrong) diagnoses.
March 11th, 2010 at 10:29 pm
Alex,
Sjogren and coagulopathy???
I didn’t get either…
March 12th, 2010 at 8:24 am
Dark urine does not mean kidney failure, because dark urine means the kidneys are still able to concentrate the urine to protect the body from too much water loss if you aren’t drinking enough for example. When the kidneys fail they produce less and less urine but they also lose their ability to concentrate urine so you’ll be peeing less, but it won’t be dark.
This article explains it in more detail: http://www.webmd.com/a-to-z-guides/acute-renal-failure-topic-overview
March 12th, 2010 at 3:29 pm
Loved the “Wilson in porn” parts, loved the speed dating parts. But could the night/day reversal that started 6 months ago have had anything to do withsomething she may have picked up on the white-water rafting trip she took, oh 6 MONTHS AGO?
March 12th, 2010 at 7:29 pm
A question for Scott:
Is there any particular reason why *this* season you haven’t put random house photos in the episode index list?
Every other one but this one has pics….
Just curious. :)
March 12th, 2010 at 8:01 pm
Official Comment
I add the pictures when I turn it into a two column list, which I do after the season is over.
March 13th, 2010 at 9:14 am
Everyone is commenting on the fact that dark urine would have been consistent. But the patient actually called her urine “muddy.” Muddy urine (”muddy brown casts”) is seen in acute tubular necrosis, and therefore NOT consistent with a bleeding diathesis from what I understand. Dark urine or bloody urine, were not the terms used. I think Foreman was right to say what he did.
Also…yeah, okay, fine, the medicine gets sloppy, but it’s not a big deal. I love your reviews Scott, and I always go through them to learn more.
However, I say this to the fans, if anything….this show does a greater justice promoting health consciousness and interest in the community that easily outweighs any misrepresentations of the practice of medicine. If fellow workers in the health care industry were using this as a primary teaching tool, then that would be bizarre and inappropriate. On the contrary, this show is encouraging the discussion and pursuit of medical treatment, innovation, ethics, and altruism.
House rocks.
March 13th, 2010 at 9:32 am
By the way, I also think Foreman might have been the one to blame. Frankie blogged that Foreman was condescending during the history taking, telling her that her recent trip was probably not relevant. It’s not at all far-fetched to imagine that if he did ask her about her bowel movements in a laundry-list-like fashion, she was put-off enough by him not to offer up a personal account of her greasy-stools, especially if he was already telling her that what she was saying was not relevant.
Patients have to feel comfortable if you want a thorough history out of them.
March 13th, 2010 at 10:23 am
The stuff they were talking about looks, women and stuff is so off.. ask any pua. Looks matter yes, but not that much.
March 13th, 2010 at 2:47 pm
@Saurabh: ARE YOU SERIOUS??!! This show does NOT “promote health consciousness…” etc., etc. If you want to break it down, this show pisses on the health care industry as a whole, patients in general, and nurses (and all women) in particular.
You are correct in that it is certainly not to be regarded as a teaching tool; its glaring inaccuracies certainly attest to that. Not to mention that NO DOCTOR in any state practices medicine the way these people do; their licenses would have been revoked years ago. The waste of money and resources to incorrectly diagnose and improperly treat patients (until House has his weekly penultimate epiphany) is unconscionable. And the sad part is, many people who watch this show think that this is how the system really works, and that the Gold Standard of medicine is to treat a long-shot (and incorrect) diagnosis with a $500 bag of IV medication when a $50 blood test would have ruled it out (the consequences of which were discussed by our fellow bloggers in the “5 to 9″ site). In the real world, if Cuddy did NOT can House for his irresponsible and “swashbuckling” approach to patients and his blatent disregard for policy, then the Board would have thrown HER out on her ass and hired someone who WOULD do the job.
As for your other comments, “House, M.D.” was created to make money. No one would watch a television show about medicine in the real world. The word “altruism” is not in the vocabulary of FOX or in the character of “Dr. House.” He’s into solving the puzzle, nothing more. Don’t even get me started on “ethics.”
But I must agree with your assessment that this website is entertaining and edifying. I do enjoy the opinions put forth here by health care professionals and those who do not work in the industry. I had pretty much given up on the show until I was told about this blog which, by my reckoning, is one of the best parts of “House.”
March 14th, 2010 at 12:02 am
It’s Turtles All The Way Down. . .
@ Tally: Actually, what Frankie says (and I have now listened to this 3 times) is that 8 out of 10 people agreed with Taylor (her boyfriend) — that is they think that salmon are animals. Thus, it is only 2 out of 10 that think salmon are vegetable. Of course that means that 20% of the people reading her blog are idiots — a large proportion.
@ Joe: As a vet, I was thinking the same thing. But you see, that is really all we have to go on a lot of the time, since your cat isn’t going to tell me that it has been having headaches or indigestion. Oh, and we watch them walk in order to see if they walk strangely. That tells us if they have joint pain or possibly a hurt paw.
@ Dr. Bulgaria: Why only the women? Why shouldn’t men vote as well? Do men not look at other men? Actually, the idea of the vote is boring. . . It’s pretty much an invasion of privacy, similar to the blog on the show.
I loved the speed dating. I think that lying should be mandatory at all such functions. It might even make dating fun. Certainly, I would lie if someone got me into one of those things. But what a horrible liar that woman was. Never use a prop when lying (especially if you can’t be bothered to fill out the crossword properly).
Finally, I really liked the ending of this episode. It reminded me of: “It’s turtles all the way down. . .”
March 14th, 2010 at 10:55 am
@medmavrx
“the sad part is, many people who watch this show think that this is how the system really works.”
I wholly disagree with that statement. Maybe kids under the age of 12 think this is the real thing, but definitely not the general audience. If you are intelligent enough to watch this show, understand the jokes, and be a fan, then you’re intelligent to know the medicine is over-done. In fact, House is consistently criticized by fans and nay-sayers alike for being overly dramatic and unrealistic.
Altruism is NOT in the vocabulary of Gregory House. It is, however, embedded in the show’s scenarios and other characters. Anyone who has watched this show consistently and seen the character development through will attest to the fact that this show fosters care and good-will. It is in fact an extremely clever juxtaposition of House’s un-altruistic character next to the rest of the team’s (Wilson, Cameron, Cuddy, etc) opinions and arguments. How many times has the episode ended on a poignant note. House’s selfishness is clearly related to his own inward sadness, which serves only to further bolster the show’s theme of altruism.
Yes I agree that a 50 dollar blood test would be cheaper than a 500 dollar IV bag, and yes people might watch the show and be more inclined to get more expensive and unnecessary tests run. That’s a problem with the medical industry with or without the show. Agreed.
However, by piquing the interesting of the public towards the field of medicine and helping our fellow beings, the show is doing a great service. We need more nurses, doctors, x-ray technicians, etc., and I believe this show at the very least promotes that need.
You don’t have to agree with the word altruism, but just scroll through any of these blog’s comments to find, as I said, the show “encouraging the discussion and pursuit of medical treatment, innovation, ethics, and altruism.”
March 14th, 2010 at 11:41 am
@Landman – I think House would be loath to discuss the ins and outs of his parental history publically, more so than debating whether faith is stupid or not. (He nearly killed himself testing that one, and it wasn’t a secret.)
@tally – 8 out of 10 of Frankie’s bloggers agreed with her partner that Frankie is not a vegetarian.
I agree that several elements of the plot were recycled – most notably the central hook of a totally honest patient v ‘Everybody lies’. In this case, House’s assertion that she was a hypocrite because she hadn’t discussed her BMs was ridiculous. (Maybe not too ridiculous for House, who needs to be armed with a confrontational opener before meeting a patient.) As her partner said, she’d developed a desire to entertain. As she said, that wouldn’t have interested her readers, and presumably it hadn’t been of much interest to her. It was also obvious, even to layfolk, that relying on a patient’s blog rather than taking a basic history including ‘What are your stools like?’ was ludicrous. That said, this treatment of the theme seemed a lot more relevant and wide-reaching – how many of us downloaded the episode? (A fair few, I bet.) How many of us are talking about it here? (Er, 100%.) How many of us make confessions to or develop opinions with online friends and sometimes have to explain the difference between those and the ‘virtual relationships’ our face-to-face loved ones accuse us of indulging in?
I had an ‘Oh, no, PLEASE’ moment at the prospect of Chadley, but I think they were playing with us. It seems that, although hot people do hook up (cf Chase and Cameron), someone in 13’s position on the hotness scale had immunity to Chase’s physical appeal, being used, herself, to dealing with superficial reactions to her looks.
On the whole, GREAT episode. The Cuddy Moment: seemed so random, and yet …
March 14th, 2010 at 5:30 pm
Seems to me that the writers were intending us to pick up on some possible Chase/13 storyline. The question is, will they go the predictable and plodding route of having them hook up and then break up, descending further into the daytime soap tedidum, or will they throw a curve ball such as Chase getting hot and bothered but 13 staying uninterested?
In all, the who’s nailing who part has never been interesting to me because their relationships have the emotional charge of CNBC. Heck, I hate that about Lost, for that matter.
March 15th, 2010 at 1:02 am
@EL Man look at other man but the general look is: “How does he do that (with women)?” Sure we can say that a dude is good looking but unless a man is gay he is not objective – he is looking at muscles, body posture, face expression he cannot judge: “Oh yeah he’s got great set of hair, lovely chippy nose or something like that” That is a girl thing and that is why I made the poll a girl thing (and it is a joke anyway, made for fun :). Do I really have to explain the differences in man and feminine view on “pretty” for a guy?
March 15th, 2010 at 5:42 pm
@Saurabh: Clearly you do not work in the health care industry. Just as clearly, you and I are not watching the same t.v. show. Just the same, I appreciate and respect your opinion (however overly-optimistic), and I apologize for wetting on your warm fuzzies.
March 15th, 2010 at 7:25 pm
Scott,
They got kidney failure wrong again tonight. Blood in the urine, not just kidney failure symptom I’m guessing.
March 16th, 2010 at 12:04 pm
[...] a couple of weeks after House featured an episode about a blogger who sought the wisdom of the crowd to help diagnose her extraordinary affliction, a [...]
March 18th, 2010 at 2:02 am
I enjoyed this episode, I thought the drama was excellent and I actually love it when I can pick out the medically inaccurate stuff! There were a couple of things I wondered about- nitpicky and to do with poop, so sorry for those who don’t want to hear about it.
1. The comparision to herbivore poo seems silly because the digestion is so different, but wouldn’t the higher fibre in a vegetarian diet make faeces softer and bulkier, not the opposite way around?
2. Surely the change would be more dramatic in such a severe malabsorption- nasty smelly yellowy diarrhoea?
Love the blog by the way, I’ve been spreading the word round med school and it’s becoming a popular read in Otago New Zealand!
March 18th, 2010 at 8:56 am
Scott, why is laying down uncomfortable for patients with valve disease?
March 19th, 2010 at 12:09 am
As I understand it (though I am neither a physician nor nutritionist), the poo issue has more to do with the difference in the amount and types of fats.
While I can’t see Chas3 as a lasting relationship, I have no trouble believing they might hook up a few times. 13 has specifically been shown being pretty casual about sex (in the episode where her thang-of-the-night was the patient, 13 didn’t even know her name), and Chase… well, he’s a guy, and apparently some people find 13 hot.
March 21st, 2010 at 1:41 pm
Wouldn’t the patient have some symptoms of her appendix getting ready to burst (i.e. fever, pain…) before it happened. I’ve never heard of appendicitis with no symptoms until after it ruptures.
March 21st, 2010 at 6:19 pm
The moment has probably passed, but Dr Bulgaria, I always love your contributions, so here’s my answer:
Chase is OK looking. He’s a pretty boy. People attracted to that kind of thing will say, ‘Yessss’. I saw him and Cameron as a good match – she was also very pretty but not the kind of drop-dead gorgeous that
13 is.
But for my money, House is the hottie (and Cuddy is roughly his female equivalent, at least among the regulars).
March 22nd, 2010 at 5:28 pm
Not that it matters a jot, but did anyone else just not care about the patient this week? Or her boyfriend? They could both have died and it wouldn’t have moved me an inch. Completely dull couple. Either poorly acted or completely unsympathetic characters.
March 24th, 2010 at 5:34 pm
I felt a little offended on the part the guy when she asked for her computer to decide on plastic or pig valve. She valued the opinions of strangers more than him when it came to a personal decision.
Other than that, I didn’t care about this patient. But I rarely care about the patient.
March 25th, 2010 at 12:14 am
Late to the party, but the Unitarian thing bugs me. I’m a Unitarian Universalist, and when I joined my current fellowship the minister asked me what I believed. “I believe what can be proved,” I told her.
“Welcome! Would you like to join our Membership Committee?” they asked.
Neither I nor the minister believe in god, and perhaps 70% of our congregation agrees. Sermons are about the quality of life, and the most important sacrament is coffee hour. (Evening forums with a wine bar are a close second.)
If House ever felt the need to join a community beyond his one-sided relationship with porn stars, he’d probably have fun arguing with UUs.
March 26th, 2010 at 11:51 am
Doesn’t the pain of appendicitis come BEFORE it bursts?
My sister’s appendix burst and she only had pain until the moment it burst. It happened on Saturday night as she was wrestling our grandmother in an effort to use the telephone to call the doctor–a total no-no in our house because we didn’t have any money.
Suddenly her pain disappeared and she went back to bed. After that she felt punk, but the pain was gone.
Our mother looked at her Monday evening, thought something was “not right” and–amazingly–called the doctor. He came to the house, took one look and called the ambulance immediately. In those days the local funeral parlour doubled as ambulance so my poor sissie had to look at the funeral parlour sign the entire 20 mile trip to the hospital. I have no idea how my mother ever paid that bill.
Three weeks after she got out of the hospital she swam across the nearby lake with our other sister and two friends. They all decided Ms. Post-Appendectomy might get tired on the way–so they made her push a rowboat so she could have a place to rest if she needed to.
March 27th, 2010 at 2:43 pm
I don’t know why the writers keep giving us a POTW who is such an a annoying human being that we don’t care whether she lives or dies. I would be TICKED if my significant other had a blog and wrote about our fights about it. There are some things you keep private. Her whole, “If i don’t write about it, I’m lying” is a bullshit cop out. She just wants her readers to agree with her and back her up.
And I’m sorry, but asking your blog readers for medical advice has got to be proof that Darwin was wrong about survival of the fittest. I actually liked her boyfriend, who stood up for himself and said if she put her blog readers’ opinion before hers, he was out of there. Good for him.
Oh, and as for appendicitis–yes, it does hurt like hell before it bursts.
April 2nd, 2010 at 9:55 am
Did you notice that rabdo has been appearing quite often in the differential lately? It’s like writers tend to “discover” new diseases. First the most frequent suspect was lupus (I even remember House’s “It’s never lupus.” comment), than limphoma, now it’s rabdo. I’m not a doctor, so it’s not for me to judge if those are more or less probable causes in most cases. I just wonder if writers “discover new diseases” or do they “discover new cases” – for example: we ran out of cases in which lupus should be considered so we grab a book, find a new “case pattern” in which rabdo diagnosis would be more appropriate. This could be done to prevent the viewers from being bored by similar symptoms again and again. On the other hand, some symptoms (i. e. kidney failure) are “a cliche” through all the seasons. Could anyone comment on that?
Very interesting blog by the way. I discovered it recently and wathing “House” got twice as exciting.
PS. Forgive me my language skills. I’m from an english-challenged country :)
April 11th, 2010 at 4:03 am
А я люблю обмазываться не свежим говном и дрочить. Каждый день я хожу по земле с черным мешком для мусора и собераю в него все говно которое вижу. На два полных мешка целый день уходит. Зато, когда после тяжёлого дня я прихожу домой, иду в ванну, включаю горячую воду…ммм и сваливаю в нее свое сокровище. И дрочу, представляя, что меня поглотил единый организм говно. Мне вообще кажется, что какашки, умеют думать, у них есть свои семьи, города, чувства, не смывайте их в унитаз, лучше приютите у себя, говорите с ними, ласкайте их…. А вчера в ванной, мне преснился чудный сон, как будто я нырнул в море, и оно прератилось в говно, рыбы, водоросли, медузы, все из говна, даже небо, даже Аллах!.
April 12th, 2010 at 10:46 pm
As a vegan, I can attest to the fact that eating more fiber (rabbit food) makes you have greater volume, not less.
As a sufferer of a chronic undiagnosed intestinal disorder, I’ve also had malabsorption issues and was immediately crying foul, since she had none of the dry skin, open sores, brittle hair, etc. *About to start on the doctor merry-go-round again. Hoping for a win this time.
Since it was an Egan episode, I was hoping for better. I was disappointed overall.
April 16th, 2010 at 7:33 pm
Scott said, “… she complains that it is uncomfortable to lie down. Chase recognizes this as a sign of valvular heart disease”
Can someone be more specific about what sort of discomfort [when lying on her back] would a sign of valvular heart disease? Would it be pain (where?), difficulty breathing, or something else?
August 5th, 2010 at 10:36 pm
Pretty belated, but the bit about 2 people thinking she was still a vegetarian doesn’t mean they think fish are not animals, just that they equate “vegetarian” to “not eating 4-legged fuzzy animals” or “not eating animals with a higher-developed brain” and thus let fish slide. It sounds silly, but it’s a commonly held view.
Also, I don’t know if the speed dating was the best place to test the “looks” hypothesis. One, you only get 5 minutes to judge someone. It probably takes longer than that to evaluate someone’s personality or whether you two have chemistry, but just a moment to judge their looks. And two, the girls that go to speed dating are clearly actively looking to meet someone. More likely to be looking to be swept off their feet. It’s not quite a representative sample. Chase might have won his bet if it had been about how many of each guy’s friends would consider dating him.
August 19th, 2010 at 12:52 am
did anyone else laugh at thirteen’s ridiculous russian mobster hat?
September 1st, 2010 at 8:31 pm
as a 3rd year MD student, I dont know enough yet, but doesn’t whipple’s entail a buildup of histocytes (macrophages) in the lymph nodes of the gut? where did the atypical lymphocytes comes in?
September 17th, 2010 at 7:40 am
Yeah, her hat. I thought it was cute how it fit her big giant head though. Anyway, ’twas a good episode, maybe not so medically correct, but fun. Prepon was nicely cast.
It almost makes me be not afraid for S7.
November 15th, 2010 at 6:09 pm
Владимир Коротов, you are one weird and creepy dude.
January 23rd, 2011 at 5:58 pm
Half the time they don’t get a full history is because the patient lies or withholds info.
March 11th, 2011 at 2:27 pm
I seem to recall looks actually being VERY unimportant in how people choose who they want. Women especially.
In fact, the whole “unemployed” angle would turn away the vast majority of women right off the bat, no matter his looks.
Some that weren’t turned away by him being unemployed would be turned away by his lack of charm.
There is no certain way to turn away EVERY woman (in spite of what Hollywood and, of course, House says, different people are attracted to different things). Strangely enough, some women would be attracted to the lack of charm and unemployment, but I can’t imagine that he would have gotten more than one or two numbers. Even those looking for a purely physical relationship are attracted more to power than to looks.
For the record? Guys don’t go for looks first, either. Surprise! Hollywood got that one wrong, too. Kindness is more important to guys than looks. Yes, the girl with the great personality is actually the girl that you want to sleep with.
Assuming the smells match up (they’re important, too… but different smells for different people).
I’m sorry. This episode is on right now and it pisses me off SO much. It’s things like these that have lead to people having low self esteem in spite of the fact that they’re VERY attractive people, just not physically (by Hollywood’s standard).
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