House – episode 15
An interesting medical mystery on this week’s episode of House: why does the mobster fall into intermittent comas? Is it the Hepatitis C he apparently acquired in prison (wink, wink, nudge, nudge)? Is it because of the mail order Chinese herbal supplements that he’s been taking? Or is it something else?
Ultimately, House deduces that the patient has OTD (ornithine transcarbamylase deficiency). This is an X-linked deficiency of one of the enzymes in the urea cycle. A full deficiency is obvious early in infancy but partial deficiencies can be harder to diagnose. There has been at least one case of a diagnosis made when the patient was in his forties, so tonight’s episode is certainly feasible. A high protein meal (like a steak) is usually the cause of the symptoms.
One would think that an ammonia level would be a test obtained early in a patient with a coma of unknown origin, and this would have pointed them to the liver (and the correct diagnosis) sooner.
Pig livers and pig liver cells have been used to purify human blood, but I have no idea if the setup would work as shown in the episode.
No researcher in his right mind would allow Dr. House to use an investigational drug that has never been tested in humans, no matter how sick the patient was. Never gonna happen.
The soap opera was at a lower level in this week’s episode, but that’s because next weeks “big choice” is being set up House has to fire one of the three Young Gun doctors. Will it be Dr Chase, whom House suspects of tattling on him to his boss? Will it be Dr. Cameron because House wants to avoid a possible romantic entanglement? Will it be Dr. Foreman because physician characters played by Omar Epps aren’t allowed to last a full season?
I give this episode an A- for the mystery and an A for the solution. The medicine earns a solid B (the investigational drug cost them). The non-medical side plots earn a B as well.
Click HERE for reviews and discussions of previous episodes of House.
March 23rd, 2005 at 11:18 pm
I finally watched this episode off the Tivo tonight, and my wife and I
noticed that… crap… the pretty blond doctor guy who’s name I always forget? He told the brother
that Hep C was cureable. Which it isn’t.
I really, really loved the bit about the toys in the nose, though.
April 14th, 2005 at 1:45 pm
del.icio.us links from the last month
» "The Chowhound’s Guide to…" Books: SF & NY / foodie book » The Paly Voice: Chinese language instruction needed at Palo Alto High School / pal,o alto high school chinese » volunteer for duveneck PTA » Grand Rou…
February 8th, 2007 at 10:42 am
Didn’t understand what was the rush about starting hepatitis C treatment. Did they even ask for a viral load or genotyping of the infection? Nah, let’s just treat it.
P.S. Ed, hepatitis C is curable. About 90% on some genotypes, somewhat less is others.
April 13th, 2007 at 9:40 am
Ed, Hep C is cureable, even in a chronic state. I’m a med student going to a German university, where one of the heads of department is reknown for his studies with Hep C. His articles show that a new treatment raises the possibility of a complete healing up to 40% for chornic HVC, which is better than nil. Also the probability of getting into remission after successful treatment is only at 5-10%.
July 26th, 2007 at 9:24 am
Actually Dr Chase mentioned that HEP C is ‘reallly managable even if not treatable’ and that’s exactly the truth unless you comprimise your liver with your bad behavior.
October 25th, 2007 at 10:01 am
I’ve just started watching this show from the beginning. Not having much of a medical background, these reviews are really helpful and entertaining! One thing that confused me about this episode was the implication that Hep C could only have been transmitted through drug use or gay sex. I suppose it was reasonable for the mob lawyer to make that assumption, but I was expecting House to offer up the possibility that his brother could just has easily have contracted it from a female sexual partner (or even an unsafe tattoo needle).
Am I missing something?
November 9th, 2007 at 7:04 pm
Why were the toys from the previous visits all still there?
Po, I had the same question, but according to Judith A. Hahn’s Sex, drugs, and hepatitis C virus, studies show a “very low risk of sexual transmission of [hepatitis C virus] in long-term heterosexual monogamous couples”, and “Sexual transmission of HCV may occur more readily in [...] behaviors that lead to blood-blood contact”.
November 28th, 2007 at 12:42 pm
Not a word about the idea that there’s an herb that would help with Gay ED but not straight “erectile dysfunction”?
December 10th, 2007 at 3:00 pm
A long time lurker here who greatly enjoys your reviews, but has never commented. I started watching House in season 3, and have now gotten season 1 from Netflix; interesting to see where it evolved from. I enjoyed this episode a lot, but had to roll my eyes at the ease with which House pulled the foreign bodies from the kid’s nose and the notion that the cat was up there all along. The minute you walk in the exam room with a toddler who has an FB up the snout, the smell tells you instantly what the problem is. There is nothing quite like it, and it is nasty. And in my experience, kids are never so helpful as to push irregularly shaped objects up there which are easy to grasp with hemostats. It is almost always a smooth round bead, now slimy, which you cannot get a grasp on. And no amount of intimidation will make them sit still while you muck about in their nostril with an instrument. But it sure is gratifying when you pull it out. And they sure missed a teachable moment by not having House point out that this kid has a lot of choking hazards for toys.
December 18th, 2007 at 6:15 pm
From the 3rd-year virology course I took, I think HepC is sometimes (but not always) curable by alpha-interferon or one of the new pegylated interferons. However, I find it odd that they didn’t mention that the patient might have contracted HCV from blood transfusions that he may have gotten when he had his previous head injury (the tire iron thing). Contaminated blood transfusions are rare these days, but still possible.
And I also agree that it was odd they didn’t check his blood ammonia levels early on since comas are readily caused by a buildup of ammonia when the liver screws up.
November 2nd, 2008 at 11:01 pm
whomsoever- They said it was marketed to homosexuals, not that it was particularly effective. :-) Lots of pseudomedication is marketed to specific social groups, usually related to the health myths that happen to be most popular in that social group.
January 8th, 2009 at 9:30 am
I loved the clinic interludes in this one. While the specifics of the medicine in House are often totally bogus, and there is often little or no method to House’s diagnostic madness, the discovery of the toy cat in the child’s nose illustrated a valuable medical meta-principle which is also pointed out in a later episode (the death row guy): Patients do things for reasons. The kid chose the same nostril multiple times, leading House to conclude there was something wrong in that nostril (which was the cat).
I am a pre-med student and I have little knowledge but a lot of interest in the ways this show gets things right and/or wrong. The notion of looking at the patient’s actions from their point of view is something I think this episode got right, even though it was only in the comic relief clinic interludes. The real-life application of this principle is important not only in diagnostics (seen here) but especially in studying patient decision-making and adherence patterns. Bump that medicine grade up to a B+.
July 25th, 2009 at 1:13 pm
Caught an error. At one point House is telling his team that the patient is in a coma with a GCS of 8. I think it’s Omar who says something like “that’s practically dead”. Not true. GCS of 8 isn’t actually a coma. Now a GCS of 3 – OK, but not 8. Google the GCS and you’ll see.
January 20th, 2010 at 9:16 am
Marc, you are wrong. The single GCS are counted together, and a GCS of 8 or lower is actually exactly that. Have no better source than Wiki, but it is correct:
Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form “GCS 9 = E2 V4 M3 at 07:35″.
Generally, brain injury is classified as:
* Severe, with GCS ≤ 8
* Moderate, GCS 9 – 12
* Minor, GCS ≥ 13.
Ergo if you score a GCS of 3, you are more or less dead, at least with respect to interaction.
March 18th, 2010 at 2:10 am
Late comment, but we just did a case study at med school with exactly this problem- OTC deficiency (though in a 6-month-old). Our metabolic medicine lecturer loves House! We even watched part of this in our tutorial, though mostly so that we could tell the tutor what we would have done in that situation… ie the right thing. For example, the whole “if you don’t admit your brother is gay, he’ll die” drama at the end is silly- it would have been straightforward to confirm OTC deficiency by measuring his orotic acid levels as well as his ammonia and amino acid levels. Though much less fun to watch!
March 18th, 2010 at 2:10 am
Also, dialysis would have worked just as well as a pig!!
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