House — Episode 18 (Season 6): “Open and Shut”
Though I enjoyed the fairly understated soap opera on tonight’s episode of House, I found the medicine to be frighteningly bad.
Julia is 35 year-old woman in an open marriage. She is just about to start a fling with her boyfriend when she develops sudden excruciating abdominal pain. She is taken to the ER where all the “usual suspects” are ruled out and she is eventually diagnosed with intestinal blockage (by which I suspect they mean a small bowel obstruction). She is admitted to House’s service not because her condition is particularly interesting, but because Thirteen knows he’ll be intrigued by her open marriage.
The team’s initial diagnosis of herpes colitis (a widespread herpes infection of the intestine) seems to be unduly focused on Julia’s suspected sexual escapades, rather than any real evidence — or the fact that there are many far more likely causes of bowel obstruction. A barium enema is ordered: it shows no evidence of herpes colitis, though Julia’s pain does resolve during the procedure.
Thirteen wants to discharge Julia from the hospital now that the blockage has cleared, but House wants to runs some tests to find out why she developed the intestinal blockage in the first place. He orders an upper GI with a small bowel follow through (have the patient swallow barium, then take a repeated series of x-rays as it slowly makes its way through the intestine). The x-rays are negative, but Julia develops a racing heart rate during the test which is later explained as an “arrhythmia.” Taub attempts carotid sinus massage to slow the heart rate (the massage should activate the parasympathetic system, which slows the heart rate), but it doesn’t work (though clearly something did as her heart rate and rhythm is normal for the rest of the show). With intestinal and cardiac symptoms, the team now suspects a parasitic cause. Neither Julia’s husband nor her boyfriends have been out of the country, so something exotic seems unlikely. A search of Julia’s house turns up evidence her husband was telling the truth about his limited travels, but also a loofah sponge, which the team now suspects she got amebiasis from (an infection by amebas).
Unfortunately, Julia’s symptoms worsen and she loses all movement in her legs. “Tests show no spinal cord injury, no cerebral lesion, and no hemorrhage.” The stool studies also come back and are negative for amebas or any other parasite. House suggests that Julia may have an electrolyte imbalance. Chase suggests that with the husband and boyfriends, she may have an abnormally high libido (i.e. her sex drive is too strong), which can be a sign of adrenocortical carcinoma (cancer of the adrenal glands). An MRI is ordered and it shows no cancer in the adrenals, but it does show a blood clot in the lungs which is confirmed by a VQ scan. The team now believes she has a clotting disorder and starts her on heparin (a blood thinner). The differential diagnosis consists of DIC (disseminated intravascular coagulation), Factor V Leiden, antiphospholipid syndrome, and Vitamin K deficiency. House has Thirteen run tests for all of them — which are, of course, normal. Thirteen now suggests pulmonary artery hypertension, but before any discussion can occur, the team is summoned to Julia’s room where she has once again developed severe abdominal pain. An abdominal ultrasound is quickly obtained and is normal. Chase thinks she may have a problem with her parasympathetic system, but Taub believes she has an intussusception (a condition where the intestine collapses down on itself like closing a telescope). In adults, this is usually caused by cancer. She is rushed to surgery where an intussusception is found. A subsequent biopsy reveals no cancer, just some non-specific inflammation. Chases reports this could be a sign of inflammatory bowel disease, but states that it wouldn’t explain the heart symptoms or the newly-developed kidney failure (oh, House season six, where would we be without our weekly kidney failure?) House disagrees, pointing out that inflammatory bowel disease can be associated with ankylosing spondylitis (an inflammatory disease of the spine), which can have heart and kidney symptoms. He wants Julia started on sulfasalazine and TNF (tumor necrosis factor α) inhibitors (both these medications work on autoimmune diseases, such as ankylosing spondylitis and inflammatory bowel disease).
Julia does not improve on the new regimen and her kidneys are actually getting worse. A kidney biopsy showed IgA nephropathy, for which Chase has kindly written the differential on the whiteboard — a list far too long to reproduce here. The team quickly decides it can’t be sickle cell anemia, celiac disease, hepatitis, cirrhosis, Alport syndrome, anti-GBM antibodies, or Henoch-Schönlein purpura (HSP). They ultimately determine the three most likely causes are hemochromatosis, Weil’s disease, and sarcoidosis and start treatment for all of them (which would include frequent blood draws and possibly deferoxamine, antibiotics, and high dose steroids). Once again, there is no improvement in Julia’s condition. The team starts to list other possible causes of her symptoms including polyarteritis nodosa and mercury poisoning. House looks at the lilacs her husband brought in for her from their garden and remembers that his father didn’t like them because they drew too many bees. The leads House to remember that Henoch-Schönlein purpura can sometimes follow a bee sting — and, sure enough, Julia suffered a sting a few weeks before. The classic rash (the purpura) is still missing, but a quick look in her mouth reveals the lesions at the back of her throat. She is started on IVIG (intravenous immunoglobulin — not a common treatment of HSP) and cyclophosphamide (a common treatment of severe HSP) to treat her condition and a full recovery is expected.
As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:
Once again, a halfway decent physical exam would have cleared this up right away (and it didn’t even have to be a good exam; a half-assed one would have worked.) Looking in the mouth? That’s really basic. This isn’t a third-year medical student mistake; it’s a first-year medical student mistake.
Herpes colitis is exceedingly rare, especially in patients who are not immune deficient. There are dozens, if not hundreds, of more likely causes. Regardless, a barium enema is not the recommended diagnostic test (though, of course, it does conveniently temporarily fix the patient’s problem without actually diagnosing it)
Technically, it is the DCBE (double contrast barium enema) which corrects intussusception, not the regular barium enema Julia seems to have received.
The ER ruled out all the “usual suspects” for abdominal pain and obstruction, but never ran a CT scan? Of course, this would have shown the offending intussusception right away and it would have been case-closed before it even got to House. (It is possible to diagnose bowel obstruction without a CT scan — it has a classic look on an abdominal x-ray for instance — but one of the first orders of business after diagnosis is to look for a cause, and that requires a CT scan).
Though we no longer follow the maxim “never let the sun go down on a bowel obstruction” (i.e. operate right away, time is of the essence!), Julia was receiving substandard care. The poor choice of tests I’ve already mentioned (and will probably mention again), but she should have had a nasogastric tube to help relieve her symptoms.
Very sloppy differentials tonight, right from the start. The team was jumping around each time a new symptoms was discovered without following any logic at all.
Why didn’t the abdominal ultrasound catch the intussusception? Or at least show a suspicious mass where it was?
If a barium enema corrected the intussusception the first time, why not try that again before rushing off to open abdominal surgery, which has much higher risks associated with it?
Thirteen wasn’t actually ruling conditions out, she was stating which ones weren’t treatable. That’s not medical care, that’s wishful thinking.
It is possible to have HSP without the rash. Depending on the study and the diagnostic criteria, as many as 5% of patients may not have the pupura.
Your standard STD panel does not generally include herpes testing because the answer is not as black and white as the other STDs. Unless you directly test a herpes lesion (which will give you a definitive yes-or-no answer, the test looks at antibodies — which are good at telling if the patient has ever had herpes, but not as good at identifying current infections. And as was pointed out, it does no good to test if the body hasn’t had time to make enough antibodies to detect.
Some clotting tests can’t be run once the patient is on heparin, though most of the important ones can (and boy those genetic tests came back fast).
The medical mystery started off slow, but picked up steam, I give it a B. The final solution seemed to fit, for the most part at least: B+. The medicine was very haphazard and illogical, but significant oversights and poor care in general. It gets a D-. The soap opera was pretty strong though, and I enjoyed it: A-.
The review of the previous episode of House
A list of all prior House reviews
April 27th, 2010 at 12:05 am
Wow, gotta say that was a pretty shocking conclusion.
How is it possible that 5 Consultant-level physicians never thought to check the patient’s mucous membranes when they were completely stuck for answers? Wait, let me rephrase that; How is it possible for 5 Consultant-level physicians to never even consider perform a physical examination upon a patient being admitted, yet still keep their jobs? Heck, even the ER could have possibly had a wee look in her mouth!
The other thing that annoyed me was the “Big Board o’ IgA Nephropathy”. Some of the things on that board should have been scrubbed off immediately. Diabetic Neuropathy without diabetes? Polycystic Kidney Disease after an abdominal US and MRI? Dissecting Aortic Aneurysm? Seriously guys, did you just need to fill out the board to make it look big and scary. They also repeated themselves a few times, like listing AGBM and Goodpasture or ‘Lung Cancer’ and Bronchial Small Cell Carcinoma.
I did however love how they just disregarded everything they couldn’t treat. Good to know that House and his Scoobies still keep an open mind with their differentials.
Apart from the last 8 or so minutes though, it was absolutely brilliant! Liked both Wilson and Taub’s stories, and I’m really enjoying Cynthia Watros so far! Hopefully she’s in it for a few more episodes yet.
April 27th, 2010 at 12:06 am
I think it’s time to to give up on House. The show use to be about the medicine first, and the soap opera second. This season it’s the other way around. I don’t need another pure soap opera, and if I did want one, I can find a far better soap opera than House.
Seems like every medicine-based drama takes this path. I guess it’s much easier each week for the writers to spin a soap opera than to find compelling medical stories.
Bye bye House. If you get back to the medicine first mantra, I will happily beg for your forgiveness.
- Greymarch
http://www.greymarch.com
April 27th, 2010 at 12:32 am
As soon as Chase called for the portable ultrasound machine my first thought was that this was going to turn into ectopic pregnancy. I guess even the writers of the show realized there would be no way that they could explain that away with all the supposed exams that she had. I probably would have kicked my television if they tried.
April 27th, 2010 at 12:45 am
Excellent review, thanks Scott.
A lot of the medicine seemed shoddy to me as well, but I’ve started looking past the medical mystery completely and, like ER in its waning seasons, concentrated completely on the interpersonal relations between the characters, which I thoroughly enjoyed.
@Jay – I kicked my TV when Taub kissed “physio girl” and got into her car. Over and over again I kicked it.
April 27th, 2010 at 12:55 am
Enjoyed the show tonight, although my DVR cut out the end, so thanks for the info that Taub got into the car. What a schmuck! What were the previews like?Anyone notice the photo of Stephan Colbert in (I think) House’s office? Has it shown up in any previous episodes? Or is this just a return salute to Colbert for House’s photo on his show?
April 27th, 2010 at 12:59 am
Ruthinor – He is indeed quite a schmuck, after all of the wonderful things Rachel has done for him, to turn around and betray her… presumably only hours or mere days after saying that she’s all he needs… what a load.
I hope he’s divorced sooner than later.
Anyone else feeling 13 + House? He looked awful sad at the end there eh?
April 27th, 2010 at 1:12 am
I have a question for all you doctor folk who post on this (I’ve posted her before and said many times that I’m not a doctor): If HSP supposedly follows bee stings, as House remembered, yet the patient only contracted the symptoms a month prior wouldn’t the sting symptoms have disappeared? (How rare of a case is HSP from bee stings?)
I thought the whole “rash in the mouth thing” was a bit of a stretch, done purely for the sake of a wow moment after losing writing steam. Unless you’re trying to eat a bee I doubt it would sting in the mouth over something more close (and painful) like on the skin.
April 27th, 2010 at 1:18 am
The purpura can appear anywhere, not just at the bee sting site, Anon.
However, I remember HSP presenting rash behind the buttocks most of the time, and nothing about “orifices” like House mentioned.
But I’m a lowly Pharmacy resident, so what do I know.
April 27th, 2010 at 1:21 am
I have known 2 people who got stung in the mouth when they drank a can of soda without realizing there was a yellow-jacket inside.
13 + House? Ugh.
Taub is a grade A++ Schmuck! I am overwhelmingly dissapointed.
April 27th, 2010 at 1:23 am
C’mon, Jen, 13+House would be great… They throw barbs so well at each other and obviously have wonderful chemistry. And let’s face it, he *needs* someone besides his Ibu.
I am disappointed as well, but not altogether surprised.
April 27th, 2010 at 1:27 am
@Anonymous:
What can occur is the bee sting sets off a chain reaction in some people’s bodies that lead to your immune system going a bit crazy and affecting parts of the body that have nothing to do with what trigerred it. Even at that, what exactly happens in Henoch-Schonlein Purpura is still relatively unknown.
With HSP, you tend to get a rash over your thighs and/or buttocks however the rash doesn’t need to be linked to what set off the HSP; she could have been stung on her arm and still have gotten a rash over her buttocks and thighs. The rash in the mouth thing is technically plausable though. I’ve never heard of a case of HSP presenting with a rash in the mouth before but I suppose it could happen. The tissue lining your cheeks is known as a mucous membrane, and what can affect your skin tends to affect there. Heck, in some disorders which lead to your skin becoming tanned your mouth can also become slightly tanned!
Hope that helps!
April 27th, 2010 at 1:43 am
The reason that 13 and House bounce off of each other so well is because 13 is the only woman who’s worked for him who is totally immune to him, and is confident enough in herself to give back what he gives out. Make them a couple, and we’ll lose that. Besides which, she has Huntington’s. She is going to need someone who will stand by her, and that is definitely not House.
April 27th, 2010 at 1:53 am
@Vsepr – agree, I don’t even listen to the medical mumbo jumbo these days. I watch for the soap and the always amusing ‘ah ha’ moment… then I check here to see what glaring errors I missed :)
I didn’t quite kick my TV when Taub kissed the extra, but I did feel a lot of ‘oh no, no’ and more empathy than usual for the poor bastard… As the show rather ham-handedly set up, he’s being led around by his wiring just as much as House (i.e., an addict).
April 27th, 2010 at 2:26 am
I missed the last thing the blonde said to Taub in the garage… help?
April 27th, 2010 at 2:31 am
I suppose 13+ House would make me like her a bit (any woman who manages to nail and/or keep House atraction deserves respect :) So Respect Cuddy!!! Anyway let us glanse through medeicine here:
1. Let us forget about the physical examination for a moment (and get an F on our 1st year exmas :) and focus on something House seems to love getting whitout going to get it himself – patient history. A bee sting? A rash in the mouth? First would be mentioned by the patient second would be the reason the patient runs to the doctor – a pretty woman not noticing a rash on her palatum? NEVER gonna happen. She would run to the doctor right away (or to the dentist:) A month and she is not even worried? Do you want to know why she whould be worried? Beacause of STDs of course – she is having sex with 10 different guys and her first thought would be STD. So a big F for that screw up.
2. I would have to give Taub credit for the carotid massage – I thought he would run for the paddles :) And you can of course shock tachicardia back to normal rhytm but that would be overkill – there are more painless and effective ways. The question is what did Taub use? They never made it clear. And the carotid massage did not seem to be working – and he did not order anything (as a matter of fact he did not seem to be doing anything usefull at all – apart from the massage that is :)
3. The final diagnosys while good would have been afected by treatments administered for earlier diagnoses – they treated for sarcoidoses (I would guess steroids and may be cylofosfamide? Or may be methotrexate? Any of those would have affected the Henoch-Schönlein purpura.
4. A purpura (in general) and Henoch-Schönlein purpura specifically would be seen on the blood panel (well something would be seen there is no way to be “normal” at least the hematocrit would be increased and probably WBC would be high; And I doubt that they never run ACE levels or the other “usuals” autoimmune panels – some of those would at least hint purpura.)
The way soap opera unfolded was pleasant – and the fact that House incited a mini crisies between Wilson and Sam with good intentions was funny and believable (Hugh Luarie made it believable – this guy is an awsome actor and I would never get tired of saying it) The twist and turns the fact that it blowed up their relationship and than put it back together and made it stronger – it was all pleasure to watch. I was kind of sad that Cuddy was practiacally missing from this episode – may be they are saving her for the final drama? Let us hope… As for Taub – predicatable, but I still got angry about it. I really like his char in the show – he is funny he plays it well, the actor Peter Jakobson is practically tailor made for a role like this – and it is kind of sad that he is bound to hurt his wife and ultimately himself. I got angry but not with him – more like with the autors who apperently think that if there is a happy end to a crisis the show would be ruined – so they just love to ruin a happy end :) bummer. I see bad things in Taubs future – poor chap but may be it will be funny to watch? Probaly will :)
April 27th, 2010 at 4:33 am
I think this whole episode is a set-up for House getting back on Vicodin. A bit of a stretch you say? No, this episode has 3 examples of “People never change” something that follows through house as much as “everybody lies” Taub cheating again, Wilson being with his ex (though actually that one doesn’t count, cos he shows he’s changed by telling her off.) and House being a bastard and attempting to break Wilson and his ex-wife up by putting the milk in the fridge door at the end (i assume that’s the implication there anyway) and if the show doesn’t get picked up for another season I assume Houses’s reaqquaintance vicodin will lead to him either ODing or stumbling in a vicodin haze off a bridge and falling into a waterfall
April 27th, 2010 at 4:50 am
Jorn, I think she said “You wanna go somewhere?”
April 27th, 2010 at 4:54 am
House, concerning the man with an open-marriage wife: “Glad the husband’s back. After missing so many little deaths, he should be here for the big one.”
Absolutely. Genius.
April 27th, 2010 at 5:07 am
No, I don’t see a 13/House hook-up, looks to me like a 13/Chase relationship is what they’ve been building up to with the way they’ve been paired off lately (and the way they commiserate with each other regarding how hard it is to be attractive).
April 27th, 2010 at 5:21 am
To this guy:
Anonymous
April 27th, 2010 at 1:12 am
Asking about the rash in her mouth still being present a month on…
The rash in the mouth wasn’t from a bee sting, it was from the Henoch Schonlein Purpura. It was the purpura, like little bleeds in the skin but in this case in the mouth. She wasn’t necessarily stung in the mouth and it wasn’t exactly a rash like they said, it was something wrong with her blood vessels causing little bleeds below the skin.
April 27th, 2010 at 5:33 am
House/13 is my dream hook-up but they will save if for the finale of the last season.
April 27th, 2010 at 6:03 am
So what was going on with the coffee machine? House giving someone a present for no obvious reason? You know he’s up to something.
April 27th, 2010 at 6:47 am
Just wanna point out that on the episode list page, this episode is numbered 17, the correct # being 18. (this is as of Tuesday, 27 April 2010, 11:47)
The list I’m talking about:
http://www.politedissent.com/house_pd.html
Keep up the good work. Your reviews are definitely worth reading.
April 27th, 2010 at 7:46 am
Hm. House / 13? Doesn’t seem like a particularly good match at all.
13 / Cameron? That’s more likely, seeing as Cam is slightly an emotional masochism, and Huntington’s is right up her ally.
April 27th, 2010 at 8:28 am
What happened to Clinic duty? I miss it!
April 27th, 2010 at 8:47 am
Agree, I miss clinic duty too.
Also, come on… she has sex 3 or 4 times a week and she has an abnormal libido? How screwed up is that diagnosis?
I’m not a doctor, but I guess 3 or 4 times a day would be more like it. If 3 or 4 times a week is pathological, I really have to check in the nearest hospital. And all of Paris (where I live).
April 27th, 2010 at 9:26 am
ruthinor, I liked the Colbert photo too…I’m guessing it is there because Colbert has Hugh Laurie’s picture on his shelf, though I don’t know why.
Anyway, I’m a lawyer, not a doctor, so the unlikely medical stuff doesn’t bother me as much as the Tritter story in season 4(?) did. But I am really hoping they don’t get House back on Vicodin, that was getting tedious. Too much emphasis on the supporting cast lately. This show is all Laurie, and though the supporting cast is good, the more House the better. I would like to see him get a girlfriend. The season opener was the best one this season so far.
Thanks for the reviews, I really enjoy this site!
April 27th, 2010 at 9:50 am
Also, come on… she has sex 3 or 4 times a week and she has an abnormal libido? How screwed up is that diagnosis?
I’m not a doctor, but I guess 3 or 4 times a day would be more like it. If 3 or 4 times a week is pathological, I really have to check in the nearest hospital. And all of Paris (where I live).
3 or 4 times a week was with her husband, presumably with the boyfriends it adds to more. Probably not pathologically more though. Especially since she didn’t have that many boyfriends.
April 27th, 2010 at 9:51 am
You didn’t pick up on 13 saying: “Vitamin K deficiency can cause thrombophilia?” I almost yelled at my computer screen when she said that!
Vitamin K is used in the synthesis of factors II, VII, IX and X (which, conveniently, was taught to us as the “TV factors” as the four main TV channels in Australia are 2, 7,9 and 10). It affects the coagulation cascade, it’s seperate to a disorder of platelet function!
April 27th, 2010 at 10:08 am
dude, u have no social life!
April 27th, 2010 at 10:21 am
If you belong to the Colbert Nation you know that Stephen Colbert counts House as one of his heroes. I laughed out loud when I saw the picture of Colbert siting on the shelf over House’s shoulder. I’m betting that once Colbert sees himself on the show he will start lobbying to be the POTW.
April 27th, 2010 at 11:56 am
So Taub has a traditional “closed” marriage although he did cheat once before. Then he talks to his wife (what is her name?) about open marriage. She gets upset. Then the next day she gives him the ok “only on Thurdays and so on”. Then she gets cold feet and she says she can’t do it. So Taub reassures her.
Finally he gives into temptation despite his pledge that he loves only her.
So how many flip-flops is that? It’s almost enough to drive a man into the arms of another woman. Although that final scene did feel wrong and forced – just inserted for dramatic efect. It makes Taub a big liar and cheater and hypocrite with absolutely no self-control.
April 27th, 2010 at 12:16 pm
@ Marionette – What? House being up to something? If you look up “up to something” in the dictionary, you’ll see House’s picture. :-)
House + 13? No way. She’s going to be getting sick one day, then her neediness will get in the way of House’s neediness and that would never work.
And I didn’t kick the TV over Taub and the other woman, but I did scream “Noooooooooooooo!” But I also suspect that this wasn’t the first time for them and everything else was a big act. I actually thought Rachel was being smart by giving him permission, knowing that would take the risk, and the resulting high, out of the equation, but apparently not. Ah, well, I hoped she was that smart, because otherwise, she’s going to be gone soon, and I really like the character.
April 27th, 2010 at 12:31 pm
Correct me if I’m wrong, but isn’t protein C deficiency an inherited thrombophilic disorder? One that would increase risk for thrombosis and thromboembolism?
If you have a protein C deficiency, it increases your risk (or at least decreases prevention) because protein C has an anticoagulant effect by inactivating factors Va and VIIIa in the coagulation cascade. Protein C is dependent upon vitamin K. So deficiency of vitamin K would decrease the presence of protein C, losing for you the anticoagulant effect of protein C.
Yes, it may still have been a longshot, but that was what they were on to.
April 27th, 2010 at 12:34 pm
But House never was about the medicine. House never had accurate medicine, it just pretends to. It’s all about the soap opera, focusing on House’s genius.
April 27th, 2010 at 12:49 pm
This was an interesting coincidence. I like to watch a program called Mystery Diagnosis, which happens to come on Discovery Health right after House is over, for my actual medical fix. Between the two shows, I’ve learned a lot about a number of unusual conditions. Last night’s episode was about a woman who had had problems with severe abdominal pain for a number of years, which had been written off as a burst ovarian cyst at first, then as endometriosis, but which was actually caused by an intussusception. As a non-medical person, I had never heard of that before last night’s House. At least I think that was her final diagnosis – I wasn’t entirely paying attention, and as I type this, I find myself thinking that an intussusception shouldn’t go on for years without dire consequences, should it? But if it wasn’t her final diagnosis, it was something they considered at one point.
April 27th, 2010 at 2:22 pm
Good soap….but I agree with others that I don’t watch for the soap. House is one of the three TV shows I watch, and I got hooked on it for the medical mysteries (yes, even knowing there was inaccurate stuff), the wit, the fast pace that required full attention, the high-quality acting and camerawork. Except for the Wilson and Taub story lines, I found this episode pretty boring. 13 is boring. Chase is getting boring. And I wish there were more to Taub’s character than a propensity to cheat.
I do find it interesting, if one can read this much into a weekly TV script, that Taub always seems to do something on the cheat side right after getting through a huge kerfuffle with his wife, bring heartbrokien at the thought of losing her and renewing his vows of singular love. Not what you’d expect…you’d expect a few weeks of best behavior before his weakness pulls him down.
Losing the clinic cases has been among the worst things to happen to the series. They provided variety, humor and an added dimension to each episode. That time has been filled in by padding the main case, which makes it boring, and adding to the soap. I’m not sure why their writers don’t seem to look at this website to see where they are leaving their fans cold.
I’ll finish out this season, then with much regret, time to say goodbye. I can appreciate that it’s not easy to keep creating at a high-level medical mystery show with interesting characters, so I’m not going to put down the staff of this show for their failures. I’m grateful for the amazingly good years it had and hope someone will come up with an equally excellent show in the future.
April 27th, 2010 at 2:52 pm
Anyone else notice that the camera work looked strange in this episode? There were several shots where the actors moved completely out of the frame for a few seconds, leaving only a shot of the empty room until they either moved back in or the camera (belatedly) followed them. It was as if I was watching a widescreen program on a 4X3 screen (that wasn’t it – I checked). Surely a professional outfit like FOX wouldn’t make such a first-year mistake, and especially not repeatedly. Was it perhaps some sort of artsy-fartsy intentional effect that this Kentucky boy failed to appreciate?
April 27th, 2010 at 2:58 pm
House has stopped giving messages. In the beginning it had a mildly edgy story that got the interest of many people. For last few years it has had a more meaningless unrealistic soap opera theme going on.
April 27th, 2010 at 3:27 pm
I love House replacing the milk. Never give up, fight to the end.
April 27th, 2010 at 3:31 pm
I suspected that the husband had poisoned “open marriage girl” with some exotic toxin or infectious agent on the stuff he handed her in the first scene. Maybe I read too much Sherlock Holmes in my youth. But in retrospect, it could have made for a more medically believable script.
@Cantare I love “Mystery Diagnosis” too. The “House” writers should watch it.
April 27th, 2010 at 3:40 pm
I really dislike straw-man send-ups. Either present the open marriage fairly, or choose a subject that is defensible and make it a fair fight.
I thought they were mean to the third wheel guy. It’s not like they told him the rules. “I’d love to respect your boundaries and stay out, but I’ve got these doctors prying into my life and my apartment and I may have a disease I got FROM YOU.”
And the insurance: What does Cuddy charge for the services of Houses team? They appear to volunteer to take cases, inflict upon the patient a laundry list of useless tests and unneeded procedures, HIPPA violations, moral hectoring and their various personal dramas, and can’t diagnose a bee sting. What appears on the bill?
I’d rather die bleeding in the street. Dr Scott, can we all watch “Nurse Jackie” please?
April 27th, 2010 at 5:07 pm
I disliked Taub since the very beginning and wouldn’t mind if the writers exchanged him for Cameron e.g. He just doesn’t fit in the group. Come on, a plastic surgeon? What he will diagnose, back pain due to DD implants? Kutner was far more funnier and interesting, too bad he’s the one that had to leave the show.
April 27th, 2010 at 5:21 pm
Colbert picture — “Open and Shut”
http://www.shrani.si/f/G/A2/1×8OEYkF/bscap276.jpg
April 27th, 2010 at 5:32 pm
“THIS SHOW BLOWS NOW”
If that is your opinion, why do you watch it? Simply watch something else…
April 27th, 2010 at 5:40 pm
Anybody notice the patient was played by former Prison Break star “Sarah Wayne Callies?”
This episode would have been much better if it was all about House trying to reattach her head.
April 27th, 2010 at 6:37 pm
Well.. the writers get a gold star for effort, but effort only goes so far when the material they are giving the actors is well…. weak, anemic and just plain not what we’ve come to expect from a world class show like House.
The POTW differentials were haphazard and seemed to follow no logical course of deductive reasoning so I agree w/ Scott that the medicine was horrid not from a medical standpoint but from a logical one.
Taub: Once a dog always a dog and as long as there’s one bitch trying to sniff his butt, he’ll be all over her no matter what he says to his wife otherwise…. while he loves his wife, it may very well be genetics that is making him act the way that he does b/c while he ‘tries’ to be good, it NEVER lasts.
I see a messy & painful divorce in his not-too-distant future…
Wilson/Sam: Looks like the writers are positioning her to stay around for a bit so it looks like the ‘war’ between Sam & House is back ‘ON’ again…. At least now he will have someone to focus his ire on again so it will hopefully get his mind off his leg..
House: Remember earlier on at the beginning of the season where Dr Nolan was telling House that he needed Diagnostic Medicine to stay focused and keep the leg pain away? I think that Diagnostic Medicine as a ‘cure’ for House’s leg pain is starting to fail, because we’ve witnessed him hitting the ibuprofen HARD last week and this week he’s been subtly rubbing the leg at least twice so the writers are trying to set us up for something… maybe a House relapse when Wilson decides to get back together with Sam & move out??
Cuddy: It’s obvious she still loves House and House knows she knows she still loves him (oh, the irony) so starting to be nice to Cuddy is a way for House to get back in to her good graces… perhaps this is a way to FINALLY get rid of that idiot Lucas for good… I wonder if Cuddy will have a ‘crisis’ moment at the end of the year w/ house that brings them back together… like a House relapse maybe?
Chase/13/Forman: Relegated to the background this week by virtue of the fact that the main Soap Opera story focused on Wilson/Sam and Taub so nothing for them to really do except run the Hospital OR by themselves again this week….
The Colbert pic was subtle, and I didn’t notice it until i re-watched the ep today… I would LOVE to see Colbert make a cameo on House, that would be sweet, but not a POTW, maybe a visiting Doctor who challenges House’s intellect in some way?
The medicine seems to be getting less and less while the soap opera is gaining probably b/c the writers realize that they are rehashing the same tired symptoms/conditions too much but are now at a loss as what to do next…
I am honestly starting to feel that House may only be around for a Season 7 next year and then get cancelled if David Shore doesn’t get his writers back in line and immediately improve the scripts next year… This years been a trainwreck after the Dibala murder and it’s been a case of the writers being REACTIVE with boring, predictable scripts instead of PROACTIVE
April 27th, 2010 at 8:19 pm
@Connie, “I suspected that the husband had poisoned “open marriage girl” with some exotic toxin or infectious agent on the stuff he handed her in the first scene.”
I thought that too! It certainly seemed like that would’ve been awesome… Or maybe he intended it to infect her / make her ill with the pathogen delivered in the documents, but instead it hit her with something else or exacerbated another condition…
Ah well. The “soap opera” is still really great and, I think it’s believable. People do have affairs, people on “teams” do gossip and are often very edgy with one another, etc.
April 27th, 2010 at 8:37 pm
“Thirteen wasn’t actually ruling conditions out, she was stating which ones weren’t treatable. That’s not medical care, that’s wishful thinking. ”
House’s team does that a LOT, and it always bugs me. I suppose I get the idea they’re trying to convey: focus on the things they can fix while they have time to fix them. But I know I’ve heard House say more than once something like “Well it can’t be [long disease name], because that would mean she’s dead anyway.” As if bothering to confirm or deny a possible cause isn’t worth the time, but another two days of pointless tests and dart-throwing is just fine. :\
April 27th, 2010 at 9:49 pm
House of past seasons teach me some differential diagnosis for abdominal pain is porphyria and guillain-barre syndrome. Both diseases can actually make legs paralized and if porphyria is acute intermittent , that could explain the tachycardia too. And they didn’t bother mentioning these diseases.
April 27th, 2010 at 10:45 pm
I do want to add that, although I know the medicine has its inaccuracies, that the show has done remarkable things for my 7th-grade daughter’s year in bio class! Maybe the best moment was when the teacher couldn’t remember the word for when someone can’t sweat and the kid piped up, “anhidrosis!” Also when the teacher mentioned people who retain too much iron, and she was ready with hemachromatosis. The project in which each student had to report on a disease? CIPA was a huge hit. Thank you, House.
April 27th, 2010 at 11:01 pm
So why is it you give a score for soap opera but never review the story?
April 28th, 2010 at 12:35 am
I liked the concept (and the producers have used this a few times on the show) that the doctor is now the paitient. (if you don’t watch prision break then you might not understand.)
April 28th, 2010 at 8:32 am
Lisa, I think House does an amazing job to let people more informed about the diseases. But they used to give the medicine more attention in early seasons.
Someone mention here about the Mistery Diagnosis. I was able to ‘diagnosis’ some patientes of it, because of what I’ve seen and read because of House. But the same things I’ve read because of House, I am using against it, and realizing the medicine could be much better.
The characters relationships are receiving much more attention. Definetely this much more easy way to create a season or a tv show, but this is not House(the series) I used to like. But this an easy to get more audience.
And last episodes this season are almost standalones episodes.
April 28th, 2010 at 9:55 am
It looked like there was a little continuity error at the end. Taub put down his briefcase behind the car before the kiss, then walked in front of the car to get in without it. Perhaps he was just dazed at how stupid the script was.
April 28th, 2010 at 10:20 am
Could one of the doctors explain why Chase suspected PARASYMPATHETIC dysfunction based on the fact that she was sexually aroused when she started having pain. My understanding of the Autonomic Nervous System is that it is the sympathetic branch that produces arousal (as in the old “fight or flight” response), and parasympathetic that slows things back down afterward. In the case of sexual activity, sympathetic produces arousal and parasympathetic triggers orgasm. So if she was in the middle of sexual arousal, wouldn’t it be the sympathetic branch that would be active?
I am also of the opinion that this show is on the skids. The first 4 seasons were magnificent. Last season is when the soap opera became primary and the medical mystery became background, but it was definitely tolerable since the dramas that played out were so interesting (Wilson quitting after Amber’s death, Foreman and 13, Chase and Cameron’s premarital difficulties, Kuttner’s suicide, House reaching the breaking point in his addiction, etc.). This season the soap opera is again primary, but it is disjointed and boring and unbelievable to a great extent, and the constant subtext – porn is good, cheating is good, lying is good – is irritating.
I noticed that between “producers” and “executive producers” and “co-executive producers” and “supervising producers” there are close to 20 producers now. I’m wondering if it’s a case of the old adage of “too many cooks spoiling the soup.”
I also noticed in the Nielsen ratings that House doesn’t even make it into the top 20 for the full season so far – that’s never happened before, not even for season 1 when people were just discovering the show. That should serve as a wake-up call to the House “powers that be”.
April 28th, 2010 at 10:42 am
Oh, I loved House’s throw-away line about Nebraska.
I am a former Nebraskan and got it right away. teeheehee
April 28th, 2010 at 12:37 pm
@Maryem, not a doctor, but i have studied the nervous system and I do know that Chase got it right. It might seem unintuitive to think that something usually not responsible for arousal is activated in sexual arousal. The ambiguity of the word arousal is at least partially to blame. Sexual arousal isn’t the same as the one triggered by fear or excitement.
Oddly enough, the sympathetic nervous system is involved in orgasm. I don’t think the mechanism is completely known, but there’s first strong activation of the parasympathetic nervous system, but it is the sympathetic nervous system that actually causes the orgasm. Kind of like an opposite of the “woodoo-death”.
April 28th, 2010 at 12:49 pm
By the way, why are so many of you dissing Taub for kissing the blond at the end? Is it really that horrible? What kind of a moral duty does he have to stay in a relationship, whole purpose of which is to make him happy? Lying about the affair could be bad, but he doesn’t have to lie, he could just tell the wife that he tried, but in the end the temptation grew too strong to resist. Of course that’s not what he’s going to do. He’ll try to hide it, his wife will find out and the world will collapse, but nevertheless, there’s nothing wrong with what he’s done so far.
April 28th, 2010 at 2:06 pm
Taub is horrible in this situation because when his wife confessed that she can’t handle an open relationship, that was the moment for him to also be honest with her and tell her that he is going to need to be with other people. Obviously at that point the marriage would be over, so he cowardly pretended that she’s enough for him and then immediately turned around and started a new affair with someone else.
And to the other person who claimed that the wife “drove him” into another woman’s arms — that’s ridiculous. He made a promise to her the last time he cheated, and he broke it. Spouses have the right to expect honesty from their partners, especially when philandering can lead to health consequences. There is more than just a violation of the marriage vows here.
April 28th, 2010 at 2:46 pm
@ Corvus They are entitled to charge for services performed with regard to “suspected ___” or to “rule out __.” Anything into which they put significant time and resources. The medical record is the legal (once it’s admitted into evidence) record of what they did. It has to be accurate.
The bill is derived from the medical record. As many people know, if the provider has billed for something not covered under the insurance plan, the insurance company will deny payment.
April 28th, 2010 at 2:52 pm
It’s funny how we are all holding on to hope for the rest of this season. I’ve never watched a more boring season of House. With the exception of the “Wilson” episode (which I thought was a long time coming) Every week has been just blah. I couldn’t even tell you what happened this year except for House being in rehab the first couple of episodes. The last few episodes are coming and we are all speculating on what we think they are leading up to but my fear is they aren’t leading up to anything. I really hope they are able to pull out another finale like when Wilson’s girl died and House had amnesia. Or when Foreman got sick. That was some good T.V.
April 28th, 2010 at 4:16 pm
Well, as far as not looking, I have had a doctor not even look at my visibly broken wrist before looking at the swelling and thinking it was infected.
By the way, work on your spelling.
April 28th, 2010 at 4:46 pm
@ Landman: What do you think Taub and “the blond” did when they left together – go out for ice cream?
April 28th, 2010 at 5:01 pm
@Blitzsgal, Taub might have been sincere in making the promise to his wife. It’s very different to keep a promise when the temptation to break it is strongly present. So he might have meant what he said, but just couldn’t keep his word. It wasn’t cowardly, just weak.
April 28th, 2010 at 5:10 pm
No, I don’t think they went out for ice cream. Whatever they did, Taub could still just tell his wife the next day and that’s it. That would be completely boring, but it would also be the reasonable thing to do.
April 28th, 2010 at 5:11 pm
“Thirteen wasn’t actually ruling conditions out, she was stating which ones weren’t treatable. That’s not medical care, that’s wishful thinking.”
I thought about that too, but then I wondered–what did they have to lose by ruling them out? If they’re wrong and that’s what the patient has…well, they’re untreatable anyway so it’s not like what they did for her kept them from treating what she actually had. And if by chance they were right (since they weren’t able to diagnose anything definitely anyway), then they save her life rather than waste time trying to narrow it down more precisely.
I wonder if that might have been the thought process, rather than the “wishful thinking” you suggested.
April 28th, 2010 at 6:43 pm
House may or may not be degrading, but it seems much more certain that the quality of medical comment on this site is degrading. It is just too easy to play devil’s advocate here.
For example, the review excoriated the team for missing the oral rash. Come on, the commentators should know that a systemic disease does not affect all organs simultaneously. Here, for example, is a case report of the rash in HSP appearing two weeks after other symptoms appear.
http://www.ncbi.nlm.nih.gov/pubmed/19687709
Supposedly missing the intussusception on CT was also criticized. This assumes an intussusception cannot come and go, which is a false assumption:
http://www.ncbi.nlm.nih.gov/pubmed/12695864
It took me about 5 minutes to find these cases on Pubmed.
April 28th, 2010 at 6:55 pm
In this case series the rash of HSP was not, in a substantial fraction of cases, present upon presentation:
http://www.ncbi.nlm.nih.gov/pubmed/12197086
Reviewers and practicing physicians should remember that the spectrum of disease is ALWAYS more extensive than presented in textbooks.
Physician hubris kills lots of patients.
April 28th, 2010 at 8:22 pm
As far as Thirteen suggesting that they cross off untreatable diseases, I think they were deciding what to test for. If they can’t treat a disease, it should probably be much lower on the list, shouldn’t it?
April 28th, 2010 at 9:32 pm
Official Comment
Xdoc, I think you’re trying to hard to find fault and are missing the forest for the trees.
1. You’re missing the point. I criticized them for not looking in the mouth during the initial exam. The fact that the rash ended up there was actually irrelevant to my argument; my point was that any hospital admission requires a good physical exam which includes looking in the mouth — something that the team failed to do.
Later in the review, I alluded to the fact that the classic rash is not always found in HSP (well, depending to some extant on whose criteria for HSP you use)
2. It’s certainly true that intussusceptions, particularly in adults, can be intermittent. However, you’ll notice that I criticized them for not getting a CT in the ER and not getting one when the pain developed a second time. In both those instances she had an active intussusception which would have shown up on the scan.
April 29th, 2010 at 12:31 am
How did the patient not know her mouth was like that for all the days she was there. And how did anyone else not notice it when she was eating or talking?
I get canker sores every few weeks and they never let me forget they are there.
April 29th, 2010 at 1:56 am
CJ Standish, I’ve done med/legal transcription, so to be sure, ‘rule out’ and reasonable tests. But Cuddy isn’t running a workers comp mill, is she? A number of procedures and test regularly appear (per Dr Scott) to be completely out of the blue. It makes it appear House ’s success rate is due less from his diagnostic genius but from trying everything in the book at a well supplied facility.
$100 blood panel
$500 rule out fungus
$1000 rule out coulrophobia
$5000 rule out Skater Boi Syndrome
$10000 Ouija board consult
$50000 rule out S.O.R.A.S.
BEE STING. I ask you.
April 29th, 2010 at 4:21 am
Regarding your grades, can you clarify how you differentiate “medical mystery” and “solution” from “medicine”? I’m a little confused as to how you can give “medical mystery” and “solution” high grades, yet give “medicine” a low grade.
April 29th, 2010 at 7:12 am
Official Comment
The medical mystery is the hook itself. Is the case interesting, or more run of the mill?
The solution looks at the final answer — does it make sense in the context of the medical mystery and patient?
Medicine is everything in-between.
So if it’s a clever set-up and the ultimate answer makes sense, medically, then those will receive decent grades — even if the rest is hogwash.
April 29th, 2010 at 9:35 am
[...] know what’s wrong. So, after our weekly kidney failure (as noted in Polite Dissent’s medical review of this episode), they start tossing around ideas until House notices some lilacs. Having nothing to do with [...]
April 29th, 2010 at 2:37 pm
@ Corvus Yes, I understand about certain tests “appearing out of the blue” and no, I don’t guess the open-marriage participant was making a Workers Comp claim for her condition. :) What was unreal was how late in the stage House thought about the insurance issue. (But it was good that, for once, he thought about it at all.) That was, I agree, a weakness in the script, at best.
If her insurance plan were a managed care company, they usually require authorization. I’m not ready yet though, to watch House sitting down, filling out insurance forms for any length of time.
I would prefer to think, imagine, that all pre-approvals, insurance authorizations, etc., have already been successfully obtained off-camera. It’s one of those necessary suspensions of disbelief you just have to have when watching any one-hour show.
What seemed really wrong to me was crossing out possibilities simply because they were untreatable. If a diagnosis were accurate but untreatable — sad, but so be it! If it’s untreatable, you don’t want to know? Because then you wouldn’t be able to do anything?
What bothers me is House et al. can see the illogic in Taub’s alibis, but can’t see the illogic in a statement like that one…..
April 29th, 2010 at 4:33 pm
And further to what you say, Standish, House (the doctor) is (I thought) something of a last resort, so it would be expected that he will try unconventional things. And a show about navigating the insurance bureaucracy would be a tough sell. (Though that one episode was fun. I like Cuddy when she’s on her game.)
We don’t diagnose untreatable diseases? Since when? That was an appalling line. I suppose it was meant to reflect a sense of urgency, focus on where treatment might be beneficial, and didn’t come across as intended in the final edit.
“…necessary suspensions of disbelief you just have to have when watching any one-hour show.”
Heh. When did ‘willing suspension’ turn into ‘necessary suspension’, I wonder? You’re quite right, and for the most part I’m willing, but my issue is similar to yours: When did ‘necessary’ turn into ‘we can’t be arsed and if you don’t like it go watch Grey’s Anatomy’ (which I am given to understand is as connected with medicine as ‘Supernatural’ is with theology).
House (the show) had initially been about something approaching real medicine. Kinda? Even a little? I am saddened that the best defense the show can muster is ‘lower your standards.’
April 29th, 2010 at 10:38 pm
“…we can’t be arsed…”? What is that, some kind of British idiom?
April 29th, 2010 at 10:39 pm
I’m with those who hope the show can recover, get back some of its medical magic. So it’s best to interpret House’s enema scene as insight into another House proclivity, rather than a metaphor for the show’s end….
Nonny Amos — that WAS a great line. Maybe the writers tried to dream up a show where it would work.
Xdoc — Go ahead & start your own site . Hubris indeed.
April 30th, 2010 at 10:24 am
Hmmm…a little online research reveals that “can’t be arsed” is in fact a British idiom that has found its way into American Urban slang. I thought I was making a joke about a typo. Guess that makes me something that’s lexically real close to “idiom.”
April 30th, 2010 at 12:11 pm
Being a medical ignoramus, this was the first time I spotted a medical goof. I’ve been waiting all week by the mailbox for my doctoring license, and now Xdoc comes in and spoils everything. Thanks a lot.
I liked House before he was introduced to the wonders of modern psychiatry. I’d rather skip the soap opera, but I’m glad some people are enjoying it.
April 30th, 2010 at 2:47 pm
Any challenge scores??
April 30th, 2010 at 3:35 pm
CJ Standish > “What seemed really wrong to me was crossing out possibilities simply because they were untreatable. If a diagnosis were accurate but untreatable — sad, but so be it! If it’s untreatable, you don’t want to know? Because then you wouldn’t be able to do anything?”
That’s not exactly what they said. They had to find something to try, and they were running out of time. So they were not going to waste time testing for conditions that they couldn’t treat anyway ; better to diminish the odds of her dying and try something that might work, should she have a curable disease. As House said once, they can test for the incurable ones when the patient is dead.
April 30th, 2010 at 8:48 pm
I loved the soap opera enough to almost forgive the awful, awful medicine. I’m actually finding the soap opera in this season as interesting as the medicine in previous seasons. But I’d prefer they do one or the other, rather than one halfway (or worse) each week. Trade off if they must. I don’t like getting to the 50 min mark and knowing they’ll now have to luck into whatever the diagnosis is supposed to be.
Taub is quickly becoming my favorite doc, in a three way tie (no pun intended, lol) with 13 and Wilson. Way to step up with the other characters, I say!
@JohnH I noticed, too and was annoyed. : ) If I have to be around for their scene, they oughta be as well!
April 30th, 2010 at 8:50 pm
Anyone know the song at the end of the episode?
May 1st, 2010 at 8:14 am
I had HSP when I was 16. I took about 4hrs and 3 consultants to diagnose it and that was on a sunday in a small town in England. It got nowhere near as serious as in the episode. I present with a arm and leg rash alone (abdominal pain and mild kidney problems did follow).
Sure I was just given painkillers for the abdominal pain. I was told the cause was idiopathic – no mention of any pre-disposing factors (i.e. bee sting)
So i actually loved this episode ‘cos it was pretty cool that my disease was on House haha
Keep up the great reviews!
May 1st, 2010 at 12:25 pm
I was thinking endometriosis for sure, especially when they found that dark red mass during the laparotomy. Maybe I’ve just been studying too much obs and gynae. Bleh, back to studies.
May 2nd, 2010 at 12:43 am
Keep up the good work Scott. Haven’t been commenting because I haven’t been watching House. It’s not as good as it used to be. Still enjoy watching seasons 1-3 and lending them out to friends. They should let Hugh return to England to his wife and family and stop making this rubbish! Your reviews however are still good and haven’t deteriorated like the show!
May 2nd, 2010 at 12:47 am
@ Alice and everyone who keeps asking for the names of songs in shows…Haven’t you figured it out yet? When your watching a show and you like a song you only have to write down a few key words and google them and voila! You get the song. Can’t believe people still ask such stupid questions!
May 2nd, 2010 at 5:04 pm
I am about ready to give up on House. It’s all soap opera and no medicine, which is a complete switch from the previous seasons. In short, it’s boring me – something I never thought I would say.
May 2nd, 2010 at 6:29 pm
My 4 year old has HSP. She’s had 3 rounds of it since January, and she presents with purpura on the buttocks, thighs and stomach, severe abdominal pain, vomiting, and painful swelling of the joints. She was in so much pain that it hurt her to be carried to the bathroom or strapped into her car seat. It took three trips to the ER and then to a Paediatric Nephrologist, as the different symptoms came up, for anyone to diagnose HSP. No one knows how it was triggered or why it comes back so often or when she’ll be rid of it…
I’m kind of glad it was on House, because now when people ask me what she has, I don’t always get blank stares when I answer.
And I totally agree that the medicine on this episode was lacking. The first thing they did when they admitted her each time was check mouth, ears, nose, etc.
May 2nd, 2010 at 8:34 pm
What song played at the end of epsiode ” Open and Shut ” ?
May 3rd, 2010 at 6:19 am
13 + House wouldn’t be a good idea! It seems like despite House being a jerk, 13 is the only main character that doesn’t like him:
Wilson is his BFF, Cuddy & Cameron loved him, Kutner had some sore of affinity towards him, Chase was noticably upset when he though House was dying, and Foreman and Taub seem more indifferent to him than anything.
On another note; at the end of the episode, was House moving the milk to help Wilson, or to break them up for the sake of it. House is falling back into his old self-loathing routine =[
May 3rd, 2010 at 5:34 pm
@George: If my source is correct, the song at the close of the show is “The Way That You Want Me” by Jude. However, I can’t find it on iTunes.
May 3rd, 2010 at 6:55 pm
Scott, how could you let House off for the Vitamin K deficiency slip? I’m a first year med student and even I caught that.
Vitamin K deficiency is one of the few things I actually remember on my differential for bleeding disorders (that and ITP and TTP). To address the above comments, my understanding is though Vitamin K is needed for both Factor I, II, VII and IX (pro-clotting) and Protein C and S (anti-clotting), in a Vitamin K deficient state you are more likely to see a bleeding disorder rather than a clotting one.
May 4th, 2010 at 10:42 pm
I’m coming in rather late to comment here, but I thought that Taub’s willingness to give in to temptation at the end was a direct result of overhearing Thirteen’s comment to the POTW as they sat at her bedside just before the aha moment.
After Thirteen told the patient that the patient’s husband had lied about taking advantage of the open marriage arrangement (i.e., that he had in fact not slept with anyone else), Thirteen convinced her that the lie was justified because it had been told out of love: to protect her feelings and to allow her to continue enjoying the open marriage arrangement herself. At that moment, Taub got a glimmer of realization in his eye as if to suggest that he owed it to his wife to make her believe that he wanted only her, rather than owing her his actual fidelity.
May 4th, 2010 at 11:39 pm
Don’t you think House need a good F***!
May 5th, 2010 at 2:14 am
well. we can say one thing about the idea that some guys cheat because their genes make them do it… The usual idiocy. The usual lack of responsibility for actions. Nature vs nurture never existed, it’s both, and this foolishness is just another excuse to be a moron.
May 5th, 2010 at 2:20 am
I find it amusing that people are speculating on a House relationship being developed. From a writing stand point, this would destroy the very essence of House except in three cases:
Series Finale, Spring Fling and Harpy: Destroyer of Worlds.
In the first, House can hook up because we never need to see how he would change his iconic attitude to handle a new woman that was really in his life. I mean, if he’s going to hook up with a woman, he’d need to find happiness in some sense or else the fans would reject it. If House finds happiness, he’s not surly. If House isn’t surly, the show is dead. So, place your bets when they get this episode ready to film, but this I think is the most likely time for a House relationship because serious relationship really does mean serious change… another break with the “nobody changes” theme of the series.
Spring Fling is fairly self-explanitory… They’ll talk, flirt, he’ll feel elated, have sex… and then just like that vicodine overdose a giant ol’ reset button will slam down in a few episodes and he’ll go back to being a surly bastard while she deals with her now hurt feelings. It’ll add some dramatic tension, but every pairing is so cliched right now that it might cause the series to blatantly jump the shark. Even a gay relationship would kinda be stretching for relevance unless the writers handled it brilliantly.
Finally, there’s Harpy: Destroyer of Worlds. The only way to not reform House’s attitude is to give him a woman just as cynical as he is. First, this would require an actress with the gravitas to go toe to toe with Hugh Laurie and put him in his place, lest the pairing not work for chemistry (this won’t be easy for a new comer, and all the current characters need to grow a pair and maybe loose a limb or something first). Next, she needs to be as petty and vain as House is, yet insufferably right. This basically means House with Boobs, except she’ll be sabotaging House in a misguided effort to “reform” him. Ultimately, it will blow up, because “People don’t change”, and a pairing like that would require one of the two to change. It can’t be House, and since the female would be House With Boobs… I again think it would ultimately be very unsatisfying for fans.
Speculation isn’t bad, but I still think the only serious contender is House/Cuddy. The series as a whole has stopped challenging us with anything worth thinking about. Look at the narrative attached to open relationships. They could have pushed for something, but instead we get taught the moral lesson that “these things never work out, everyone is miserable.” A fight bringing a couple closer together is hardly groundbreaking, so unless the medical science is intel- oh… right… D-…
The series no longer knows why it’s here besides the advertising dollars. Only reason I’m watching it now is because I barely have anything else to watch. And getting to see Hugh Laurie act like a pompous ass is kinda fun regardless of what else is going on.
May 5th, 2010 at 4:02 am
[...] medicina passa decisamente in ultimo piano questa settimana e sembra anche poco accurata (dai, nessuno che abbia guardato prima la gola di Julia?). Julia soffre, ma non sembra mai davvero [...]
May 7th, 2010 at 4:22 am
Also not a physician, just a lowly 1st year PA student working toward my third career and with that disclaimer aside, I want to comment on the medicine and the drama. I was married to a critical care/pulmonologist for many years from residency through fellowship, into attending, and I think the portrayal of the physicians is pretty spot-on. My ex cheated on me with of all people–a nurse, so Taub’s indiscretions are very believable. If House gets with 13 I will stop watching. The age difference is enough of a turn-off, and couldn’t possibly move the narrative anywhere good, plus 13 is due for another lesbian foray post Foreman, after all, she is bisexual and we haven’t really seen her in a relationship with another woman.
Insofar as the medicine, from a just-past-layman POV, it’s the little but obvious details that get to me like the aforementioned ‘big board’ and its duplication of possibilities. Certainly, the physical exam being skipped and discovery of purpura at the end was totally implausible. I wish they had made the results of previous treatments on the actual condition more realistic as pointed out by D-r Bulgaria, though I take issue with a number of his other ‘observations.’ The wife had only 2 sex partners over the past 6 months, not 10, women do not often look at their palatum, even “pretty” ones, and after the carotid massage, Taub called for a crash cart, so we can assume he did something to deal with her tachycardia.
One thing I notice with every episode is that I stay on my toes looking for mistakes or what they do right and filter it through my current learning experiences and prior knowledge.Since I’ve only been watching House since season 5, wondering if HIT (heparin-induced thrombocytopenia) has been tackled. Anyone recall? I learned quite a bit about it while editing a presentation for the ex and was surprised to find it is often missed and is under-diagnosed. Anyone?
May 7th, 2010 at 4:55 am
And by the by Scott, I love your place and your House reviews. Best-medical-blog-about-a-tv-show-ever. Thank you for your service and I’m a USAF vet as well (the ex is still active duty).
May 8th, 2010 at 5:45 am
it was wonderful 2 see sarah wth dr house
but i think that HSP is more common at age 2-6 yrs
so it is rare 2 c sarah has HSP
May 8th, 2010 at 5:47 am
again i would like 2 than Dr Scott for his effort
really i have made use alot of ur effort
thank u alot and i hope u all Success
Dr_keshk
May 11th, 2010 at 1:17 pm
Here’s a website which lists the songs used in each episode of “House”.
http://www.have-dog.com/house/
By the way, this is coming from a man whose (now-ex) wife was recklessly unfaithful. If she got sick while getting down and dirty with her boyfriend, I’d say to the boyfriend “She got sick while she was with you. Now, she’s your problem.”
May 15th, 2010 at 2:25 am
I’m sort of wondering about the insurance. Cuddy discovers the PotW has no insurance, due to her husband losing the money (though it’s not clear how; it sounded to me more as if he invested it, though of course that means he wouldn’t have the cash flow). Cuddy tells House to stop with the unnecessary tests before he bankrupts them; House says he’s already way past bankruptcy. The patient phones her insurance company and — what? — convinces them to give her retroactive insurance? From what I hear of U.S. insurance companies, she’d be lucky to get insurance for future conditions, out of luck with the current one. Yet she stays in hospital and House continues to order tests.
Is this even vaguely realistic? What would happen in the real world in the U.S.? Would they continue testing and treatment even though they all know the patient and her husband haven’t a hope in hell of paying it, and then send collection agents after the couple for the rest of their lives? Would they turf her out to a free clinic, knowing that it is only equipped to treat horses and not zebras? Would they send her home to survive or die the best she could?
May 15th, 2010 at 9:32 pm
I’m not suprised at Taub, i knew he would do her. When his wife said it was ok he didn’t want to do it because he lost the thrill of doing it (its no fun if the other person knows, it makes you too guilty). Thats why when she said she couldnt do it I knew he was gonna do it with the other girl. he wants the thrill of being a 5′4 balding man who has two sexy girls.
I’ve also started to realize that the medicine needs to be messed up to a degree (of which changes from bad to worse depending on the episode) if it was real life they would be able to plow through 10 people an hour and adding in more people to do the different surgeries and procedures and trying to sneak in the mystery and add the drama would make House great but unmanagable and eventually too much of a hassle. I like House as House, not House as ER (no offense to ER).
I have a quick question for Scott: Would’nt a rash like the one she has in her mouth be dry or hurt or something like that for a while like every time she ate or drank?
June 2nd, 2010 at 6:08 pm
What I don’t particularly appreciate about this episode, not to mention this medical review, is that HSP often causes more severe complications in adults than in children.
Studies show that of adults over 18 years of age who come down with HSP, only 20% of individuals experience long term remission. Most adults that experience HSP end up with some type of renal complication. In particular, 11% of patients reached end-stage renal failure, 13% exhibited severe renal failure (CrCl <30 ml/min), and 14% moderate renal insufficiency (CrCl <50 ml/min).
Magically however, the patient is given a few prescriptions and everything is better. As a 25 year old that was diagnosed with HSP and continues to experience renal issues, I find this extremely disheartening.
Minimally, people who suffer from chronic diseases should have there plight properly presented to the world, whether through television or through blog posts.
All the figures presented in this post was pulled from the following journal: http://jasn.asnjournals.org/cgi/content/full/13/5/1271
June 3rd, 2010 at 1:01 am
I take it that I’m the only one to notice the cereal on the counter was “Colio’s”? (The box implies that its a high fiber cereal, and cleans your colon out.) Its a pretty funny gag and I’m somewhat surprised, given that House (along with many other TV shows) does a lot of product placement that they didn’t find a cereal company willing to pony up money for use in that scene.
June 13th, 2010 at 7:14 pm
Love your reviews. Keep up the good work.
August 20th, 2010 at 10:14 pm
Hi All…..My daughter got HSP when she was 6 years old…here are some of the symptoms she had…
her first symptom was quite a few bad bloody noses months prior, but I didn’t know it at the time. I thought it was from the forced hot air, it even happened in Toys R us gushing everywhere in front of a bunch of little ones too :( Then a sudden extremely swollen knee…followed many other symptoms such as rash above and what seemed below the skin too(purpura). Bruising on the palms of her hands. Eventually the swelling went down one side of her body and up the other in clusters. It also attacked her stomach and intestines. Severe vomiting for several days, The purpura also traveled around to different limbs but her buttocks were the worst. A severe purple rash so bad it looked like she was beaten by someone. Of course they questioned me in the ER cuz they misdiagnosed her and I knew it, so I took her to her pedi asap. and he knew it right away. She was sick for a few months missing school and activities. Luckily it didn’t attack her kidney’s or liver. At 15….she is just now growing out of it and still has heel pain to this day.
November 25th, 2010 at 11:48 am
I was SO disappointed with Taub at the end when he went with the blonde, but I know why he did it – when his wife said no to the open marriage, he was disappointed but accepted it. Then he overheard someone (13?) saying that sometimes you have to lie to keep the people you love happy (relating to the husband’s money issues/not sleeping with other people), and you could see Taub’s cheating little ears prick up, as he used that to rationalise cheating on his wife!
I’m actually really enjoying this season of House. I love the soap opera side of it – I find the medical mystery interesting, but it’s the interactions between the characters that I love most, and I think they’re great this season!
June 8th, 2011 at 5:39 pm
Sorry to be a late-comer, but I live in Germany and do not want to watch the dubbed version so I have to wait until the DVDs hit the rental place. So while in the real world, Season 7 has just ended, I just got Season 6. And at the moment it’s rather late at night so I didn’t read more than half the entries on this episode, but after reading speculations above about maybe House&Cuddy getting together, and another about maybe Wilson moving out to have a life with Sam, I thought: That’s it! And then Cuddy moves into her dream condo with House! Still, kinda hard to picture them having a life together, little kid and all. That would call for some major development on House’s part. Are the writers up to it?
By the way: great reviews! Thanks!
September 24th, 2011 at 5:36 am
The first point in red about doctors not looking in her mouth in beggining – Yeah that was exactly my thinking there; I have almost no clue about medicine, and I would still check her mouth first. Even some normal village doctor when you have a cold does that.
What is even weirder – her husband and none of her lovers never looked at her mouth?!? And didn’t even feal nothing weird when they kissed her?
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