House - episode 12
A superstar baseball player suffers a sudden fracture of his right upper arm. X-rays show a generalized osteopenia (thinning of the bones). Since the most common cause of osteopenia in younger individuals is cancer, other (very expensive) tests are run, but no cancer is found.
Other symptoms this patient is suffering include kidney failure, liver damage, hallucinations and hypogonadism.
Now, this player admits that he was once a drug abuser — of the hallucinogenic and stimulant variety. He denies steroid use, though under duress admits he may have used something his trainer gave him once. As the story goes on, it turns out that he hasn’t given up drugs entirely and has been using some marijuana “to relax” now and again. It seems that this marijuana was grown in ground contaminated with cadmium, and his symptoms (and his wife’s anosmia) are due to cadmium poisoning.
Cadmium poisoning is nasty, and can certainly cause the symptoms mentioned — except the hallucinations. In addition, cadmium poisoning usually has respiratory symptoms and lung and prostate cancers are common. (It was probably the morphine causing the hallucinations; I’ve seen patients with similar hallucinations — talking to people who aren’t there — on morphine. )
(Please note that this is different from Cadbury Poisoning, which is an overdose of chocolate. This condition seems to be most common around Easter.)
Dr. House initially believes that the patient is lying about not using steroids, and that those steroids are the cause of his hypogonadism. He starts to treat this with Lupron (leuprolide acetate). Admittedly, this area of medicine isn’t my specialty, but this makes no sense. Lupron suppresses the production of sex hormones, something the patient is already low on. He is causing hypogonadism in a patient who already has that problem. Furthermore (according to the story), since steroid-induced hypogonadism wasn’t the cause, the Lupron knocks the patient into respiratory failure. This also makes little sense as Lupron is not associated with respiratory failure (but it is a good example of a common theme on House: a treatment will either save your life if the diagnosis is correct, or kill you if the diagnosis is wrong).
Other side issues in this episode include transplant ethics, digitalis toxicity, ex-girlfriends, sleeping with drug reps, and monster truck rallies.
This episode earns a B+ for the mystery and an A- for the solution. The medicine earns a D (the cadmium was clever, but the Lupron was ludicrous). (I give the minor side plots a B+ because they almost salvaged the bad medicine.)
February 23rd, 2005 at 12:53 am
I’m glad I’m not the only one who’s noticed this zero-sum game of diagnosis and treatment they’re doing on the show. The impression of medicine the show leaves is that your doctor better be better than competent, otherwise a common cold will lead to death.
Of course, that is a possibility… up here in Victora, a girl went into emergency with flu symptoms and was sent home. Turned out to be meningitis and she died… hrm.
Not sure what to draw from that, but it does occasionally bug me that if they’re wrong, the patient is on death’s door.
February 24th, 2005 at 3:33 am
Cadbury poisoning. Perfect!
October 21st, 2006 at 11:47 pm
I’m definitely not a doctor, but I just ran through the episode on my DVR.
The hallucinations were not caused by the cadnium poisoning. Those were caused by the medicine he tried to use to kill himself.
Wilson: “Hallucinations would point to digitalis, it would also mess up his heart.”
October 22nd, 2006 at 2:44 am
I am fairly new to this program and have only watched a few episodes. This episode had
me screaming at the TV set fromt the beginning. I actually stopped watching after a while.
Steroid use was the first assumption made when osteopenia was found. Anabolic steroids,
the kind that athletes use, causes an increase in bone density, not a decrease!
The kind of steorids that cause osteopenia are the kind used to treat inflammatory diseases etc. This is
pretty basic. Does this show have medical advisors?
October 28th, 2006 at 8:11 am
The main problem of the series is the manner of coming to a diagnosis. Not based on history taking, physical examination and routine tests. After these the more sophisticated, expensive and even invasive test could be performed. The patient in thise show could die from kidney failure, what happened to dialysis? A kidney transplantation takes an average of one half year of preparation in case of family donation. No nephrologist or surgeon will perform a tranplantation on a very sick person, one should be in a better shape, trough dialysis. The show is good, because they show us not the surgical side of medicine. However shown in this way one should better cancel it.
December 29th, 2006 at 10:06 am
How common is marijuana grown in soil contaminated with cadmium? are there any ways to “flush” out the poison?
May 26th, 2007 at 12:00 am
what? the cadmium poisoning was quite possibly the greatest solution yet!! i think it deserves more than a mere A-
June 5th, 2007 at 12:17 am
no one’s going to mention the clinic patients he diagnoses on the way out the door?
July 8th, 2007 at 6:38 pm
gotta love that last kid. “I’m can’t see” LOL
May 6th, 2008 at 8:28 am
Yeah, i missed that too in the review…
When House diagnosed 4 patients on-the fly, I expected Cuddy to to be pissed, because to me (no medical skills) that seemed wrong. Patients have a right to privacy and although House is a loose cannon, Cuddy shouldn’t have let him off so easily, even though it was for a greater cause. (those were some great tickets)
October 11th, 2008 at 10:31 am
So Lupron has no connection with treating steroid abuse whatsoever?
I admit I’m somewhat confused here. Why would they put a totally random drug in like that? How much time does it take to open up a medical book and see, “What’s the usual treatment for steroid abuse?”
October 11th, 2008 at 10:37 am
Sorry to double-post, but I just remembered: anabolic steroids work by boosting testosterone, right? So I guess I can at least sort of understand why the writers would make that mistake; “they’re taking a testosterone booster; let’s give them a testosterone-reducer”.
December 12th, 2008 at 8:39 pm
http://www.wisegeek.com/what-is-testosterone.htm
December 13th, 2008 at 6:20 am
Lupron not connected with respratory problems…
the following link says otherwise -
http://medical-dictionary.thefreedictionary.com/Lupron
December 13th, 2008 at 6:26 am
Official Comment
No, I said Lupron wasn’t associated with respiratory failure, which is different than the respiratory problems mentioned in the link above (which is essentially a reproduction of the possible side effects from the PDR.)
January 11th, 2009 at 10:55 pm
I love how at teh end he says, put him on the treatment for cadmium posioning. I’ve looked it up - there is no treatment for cadmium poisoning.
January 15th, 2009 at 2:53 am
Is there any cure for minor cadmium poisoning?
I think my friend might have gotten it.
He has felt… Different in the last month or so.
He has lost hair, felt tired, experiencing headaches, etc.
I told him it is possible that he had smoked cadmium-laced weed.
He does occasionally smoke marijuana
February 26th, 2009 at 1:36 am
What are the chances someone would pick particularly poor cadmium-poisoned soil to grow marijuana? Now, tobacco sequesters cadmium, but I couldn’t find any citations supporting a similar effect for marijuana. I love House, but I don’t think this was a particularly plausible episode.
May 25th, 2009 at 2:56 pm
Lupron is a gonadotropin-releasing hormone agonist (GnRH agonist). It suppresses sex hormone production if it is given continuously. However, when given in a pulsatile fashion, it stimulates sex hormone production.
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