House – episode 13
I knew it was going to be a bad episode when they pulled out the Ouija board in the first five minutes.
The patient is a twelve-year old boy who presented to the hospital with a week-long history of a fever, respiratory symptoms and a rash. Various kinds of the atypical pneumonia were considered, including Legionnaires’ disease and chlamydial pneumonia. Several jokes are bandied about concerning twelve year-old boys and sex, and the patient gets a sexual history taken. But wait a minute! Chlamydia pneumoniae, a common cause of atypical pneumonia, is a completely different from the sexually transmitted form of chlamydia (C. trachomatis). Any infectious disease expert, and even a medical student, should know that simple fact.
The team discovers that the patient has developed anthrax, which they claim would explain both his rash and respiratory symptoms — except that cutaneous (skin) anthrax and inhalational anthrax are two different and distinct forms of the disease that don’t cross over. The skin infection makes sense considering the opening scene of the episode where he fell on an infected piece of insulation, but suggesting he somehow breathed in enough spores at the same time to cause the lung infection is hard to believe. Furthermore, ciprofloxaxin (Cipro) is still the preferred drug for anthrax, not Levaquin (although Levaquin is suspected to work against anthrax).
The patient begins to develop symptoms that go beyond anthrax. The team looks at a variety of additional diagnoses including various autoimmune diseases and neurofibromatosis. They obtain manyfancy tests (which they run themselves, with no help from people who are actually trained in the procedures), but they tell nothing. As usual, they place him on some particularly powerful and risky treatments based on little evidence. The treatments seem to help a tiny bit at first, but then he begins to lose control of his hand. Ultimately the true diagnosis is made: leprosy. Apparently the patient had dormant leprosy which made him more susceptible to the anthrax which in turn reactivated the leprosy.
There is also an underlying theme of father/son relationships in this episode, contrasting the relationship of the patient and his father to Dr. Chase and his father.
One last question: How did Dr. Chase’s father, an Australian rheumatologist, get credentialed to act as a physician in the hospital that quickly? Does he have a New Jersey medical license? How did the California doctor get similar privileges so quickly in that Episode 9?
The medical mystery this episode earns a C, but the leprosy solution brings the score up to a B. The actual medicine is pretty poor with too many freshmen mistakes and earns a C-. The side plots earn a C, they were just average.
March 2nd, 2005 at 9:19 am
Did you notice that when the female doctor mentioned
Levaquin she called it “the best antibiotic we have?”
Do you smell the stinky stinky taint of a “product placement?”
March 2nd, 2005 at 9:28 am
I noticed that, and the fact that they used the brand name instead of the generic name. They did the same thing with Lupron last week. However, both times they’ve highlighted a particular brand of medication, they’ve used it for the wrong indication. If I were Ortho-McNeil or TAP Pharmaceuticals, I’d want my money back.
March 2nd, 2005 at 2:39 pm
House,MD is a Crock of S**t, Vol. 2
Watching the episode airing on March 1st: 1. I loved, again, the misconception that doctor’s go out to the scene of infection to collect samples. Maybe the CDC, but not common docs. Jumping out the window to get away
March 2nd, 2005 at 2:40 pm
Nice to see someone else ripping this POS series to pieces. I found the Rapid Sequence Intubation they did to be laughable (by the neurologist, no less).
March 3rd, 2005 at 12:39 am
The thing is HOUSE isn’t a medical show. It’s a cop show, dressed up in hospital. The disease is just the criminal they have to corner.
February 11th, 2007 at 9:12 am
The doctors didn’t wear masks. Anthrax is very communicable but not one of them was concerned. I guess production ruled in favor of aesthetic aspects rather than presenting reality. But see, it doesn’t matter if the series has flaws as long as the show delivers. I don’t mean to sound so Machiavellian but I guess this is the part where his principle applies. Television shows especially series have to be provocative to survive. Sometimes these shows could get away from presenting what is actually happening in the hospital for the simple reason that reality could sometimes be boring..
April 2nd, 2007 at 12:18 pm
I agree with Jatser on the intubation … I saw it and the first word out of my mouth whas “WHAT?!?!?” quicly followed by “the” and another word that I’m sure most people can guess. Last time I checked you sedate, paralyze and then intubate … and Ativan (lorazepam) … that just ain’t right.
April 20th, 2007 at 1:48 am
One thing that amused me was the discussion of a short course of antibiotics “curing” leprosy, which is really unlikely; leprosy is treatable with antibiotics, but because of its life cycle, it’s only curable with very long courses of antibiotics – usually (always?) on the order of years.
April 25th, 2007 at 3:26 pm
When they mentioned the Thalidomide as treatment, why did Cameron balk at the idea? Aside from the fact that a 12 year old boy obviously won’t be having kids, I thought the problem with Thalidomide was that one stereoisomer worked differently to the other, and that nowadays they seperate out the two different forms, so it’s safe to use.
At least, that what I remember from my chem classes. Is that right?
May 31st, 2007 at 8:30 am
How about the father’s carpal tunnel being caused by leprosy? Is that accurate? I ask because my mother in law claims to have carpal tunnel which surgery did not fix. Could it be due to leprosy? She is from India.
Thanks!
June 5th, 2007 at 12:33 am
soooo what you’re saying is that you want someone on an anonymous messageboard to diagnose your mother with leprosy? huh.
June 6th, 2007 at 5:36 am
Yes, that’s why I presented all her symptoms and medical history.
Actually, I was just asking if leprosy could cause symptoms similar to carpal tunnel. Like what happened to the father? In this very episode? That we’re discussing?
July 8th, 2007 at 6:52 pm
The father did not have carpal tunnel. He had leprosy which, according to the show, damaged his ulnar (sp?) nerve and was misdiagnosed as leprosy. This was mentioned to be an atypical presentation of leprosy. If your mother-in-law has a positive diagnosis of carpal tunnel and no other symptoms that indicate leprosy, then there is no reason to think that it might be leprosy.
July 12th, 2007 at 3:25 pm
“I thought the problem with Thalidomide was that one stereoisomer worked differently to the other, and that nowadays they seperate out the two different forms, so it’s safe to use”
You’re right about the fact that the two stereoisomers of thalidomide work differently, with one having the indicated effect against morning sickness during pregancy (S-form) while the other is teratogenic (R-form). The problem however is that the two forms interconvert rapidly in the body (because a weakly acidic hydrogen atom), so you will eventually end up with a racemic mixture even if you start out with just one stereoisomer.
July 23rd, 2007 at 2:56 pm
does leprosy have a cure ?
I am not a doctor, but I read a few things here and there.
I know that one of the cures forleprosy is thalidomid (spl. ?), and a visual check (read it on thomas covenant books), but other wise it’s a chronic disease that doesn’t get better.
is it treatable or even can be cured ?
I understand that no one knows why people get it, but it comes usualy with alot of bad hygene ?
October 17th, 2007 at 4:09 am
I have a burning question about this episode and have been unable to find an answer other than it’s a glaring mistake: Berger’s disease? (Burger’s?)
they say:
Cameron: Burger’s disease. Foreman: He’s never been out of the country.
huh?
“Berger’s” disease is: IgA nephropathy (also known as IgA nephritis, IgAN, Berger’s disease and synpharyngitic glomerulonephritis) is a form of glomerulonephritis (inflammation of the glomeruli of the kidney).
and
“Buerger’s” disease is:(also known as thromboangiitis obliterans or bgritis, an acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. It is strongly associated with use of tobacco products,[1] primarily from smoking, but also from smokeless tobacco.
neither has anything to do with non-american geography.
what gives? what are they talking about? parallel universe?
June 14th, 2008 at 2:34 am
Is Thalidomide really a treatment for Leprosy? The wikipedia article on Leprosy says they treat it with other antibiotics.
August 23rd, 2008 at 4:51 pm
“does leprosy have a cure?”
Yes, it has a cure. It is a long term treatment, but it works.
“Is Thalidomide really a treatment for Leprosy?”
Yes. I’ts not the default treatment, but it’s an option.
August 25th, 2008 at 9:57 am
In the beginning Cuddy tells House that Gabe´s pneumonia doesn´t respond to ceftriaxone. I have doubt ceftriaxone would be the first choice to treat pneumonia, especially when caught outside the hospital.
September 17th, 2008 at 2:47 am
I had watched this episode and last nite’s and was really surprised at the outcome. Cursed was one of the best shows about Leprosy as it includes so many symptoms. When I first watched this on the DVD set I had bought. I guessed the father and the boy had leprosy from the get go when Dr. House nailed it in their discussions.
they say it’s really that contagious. and it’s curable with the MDT’s(MultiDrug therapy. and also Thalidomide. but was surprised to find out that they gave it thru an IV drip.
September 17th, 2008 at 2:53 am
ooops sorry, a typo. i Meant that it was NOT that contagious.
Monk had an episode about Hansen’s Disease (aka Leprosy.also.
I’m surprised that they coulld still phone up Carville, LA for a supply of Thalidomide since it’s no longer a Leprosarium and is owned now by the National Guard in front and has a Museum in back?
Also nobody who has or contracts Leprosy has to be sent there and can now be treated by their regular doctors.
November 6th, 2008 at 4:58 am
Carpal tunnel syndrome affects the median nerve, not the ulnar nerve.
November 9th, 2008 at 1:08 am
I’ve started reading these recently, as the broadcast channel’s been showing them from the first episode on, and it amazes me how often the doctors go out themselves and have to break into houses to get environmental samples.
Like in this episode, they couldn’t contact the owner and request to get a sample? I think they wouldn’t have a hard time with that. Of course if they’d asked permission then you’d never get the fun scene of Dr. Chase meeting the stoners.
November 13th, 2008 at 11:38 am
Just a nitpick.. House was talking about the ulnar nerve in reference to the carpal tunnel (which it turned out not to be), but carpal tunnel is a compression of the median nerve, not the ulnar nerve.
December 21st, 2008 at 10:36 pm
I disagree with the C on the sub plot. I thought the sub plot was unexpected and different. I mean, of all things who was expecting Chase’s dad to show up? I think this episode was also a big part in the whole show because, in the first season we are learning more about all of the doctors,and I think this was a very important episode in that process, because we learned about Chase’s past.
January 8th, 2009 at 9:11 am
re: the anthrax – I assumed the doctors received Anthrax vaccines as soon as the diagnosis was made. I would still expect them to exercise precautions, but their lack of terror of contracting the disease would make more sense if they’d already been vaccinated.
February 2nd, 2009 at 7:51 pm
Nobody said they cured their leprosy with a short round of antibiotics, a cure takes months or years. However, a patient stops being contagious as soon as he/she starts multi drug therapy. Furthermore, if those who have been in contact with the infected receive even one dose of rifampicin they have up to 75% less chance of getting infected themselves. Combine this with the fact that 95% of the population is naturally immune to the disease and you can see that this really isn’t a problematic disease (if diagnosed correctly) in the developed world. The only problem is, since the disease presents itself with very few distinct symptoms initially, by the time you diagnose it correctly irreversible neurological damage can occur.
April 22nd, 2009 at 9:23 pm
@ philantropist :
Anthrax isn’t contagious. At all. Its only danger is that when you inhale it and it infects your lungs, survival is only about %10. So Dr. Chase was correct in wearing the mask to take the sample, and leaving it off the rest of the time.
May 18th, 2009 at 12:09 pm
@ Sid and others about thalidomide – It is used in one of the complications of Leprosy called Erythema Nodosum Leprosum, an inflammatory reaction to dying lepra bacilli in the system. It is no more recommended in the treatment of such reactions. (See http://www.who.int/lep/research/thalidomide/en/index.html ). Steroids are used instead.
July 21st, 2009 at 10:38 pm
Just to be as nitpicky as possible, when House looks through the scope at the suspected insulation, those are most certainly not animal hairs he’s looking at. There is no scale pattern at all, seemingly. The medulla is also discontinuous which is not very common in animals, and it is also much too small; the medulla looks more like a human’s. Animal medulla are usually 1/2 to 2/3 the overall width of the hair.
August 27th, 2009 at 5:13 pm
I love this show (and Baba O’Reilly by The Who), but i also like reading these bloopers too!
It’s not a medical show, it’s about a bloke who can’t relate to other people – just like my hubby…
Can’t wait for him and Cuddy to get together – now i’m just being soppy…
January 20th, 2010 at 4:11 am
Thalidomide caused fetal limbs to degenerate because it blocked the blood vessels; so the limbs degenerated because of oxygen deprivation. As far as I’m concerned, it works the same in certain forms of leprosy, by blocking the blood vessels feeding the parts of skin affected by the disease, so they degenerate and die, and the mycobacteria with them…
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