House — Episode 12 (Season 7): “You Must Remember This”
A below average episode of House with more-unrealistic-than-usual medicine and a more-unrealistic-than-usual final solution. At least Wilson was back this week.
Nadia is a waitress in her mid-thirties who has perfect memory — she never forgets anything, or anyone. One day at work, she suddenly collapses, both her legs paralyzed. Though it is just a temporary paralysis, she is admitted to House’s team for work-up. In addition to the episode of paralysis, she is also noted to have elevated CK (creatine kinase, a muscle protein) levels. There is debate among the team about her perfect memory, and whether that’s a symptom or not. An MRI of her brain was negative for stroke or tumor (notice how carefully that was phrased: not a negative study overall, but just negative for those two specific diagnoses). The initial diagnostic suggestions include toxin exposure, botulism, or alcoholism. Half the team is sent to look over her house, while the other half performs a thorough physical exam (which they should really do for every patient anyway). The search of her house turns an empty bottle of laxatives, so Taub suggests magnesium poisoning. House discounts that suggestion. Noting that the patient is constipated, he asks her how many times she’s stumbled or fallen over the past several years. As he suspected, she is falling more now than she used to, and he diagnoses her with early onset Parkinson’s disease and starts her on levodopa.
Nadia’s sister Elena stops by to visit and it is clear there is some unresolved issues between them. Nadia’s heart rate skyrockets — a wide complex tachycardia (an elevated heart rate that originates in the ventricles. This can degenerate into fatal arrhythmias like ventricular fibrillation so defibrillation can be appropriate). The cardiac symptoms mean that the diagnosis of Parkinson’s was wrong, so now the team throws out the ideas of elevated catecholamines (stress hormones such as adrenalin. High levels can occur with a pheochromocytoma), or long QT syndrome (an inherited heart condition that can lead to life-threatening arrhythmias) worsened by the stress of her sister’s visit. Under House’s suggestion, the team performs a cardiac stress test on Nadia using a fight with her sister as the stressor. The test is positive and she is started on beta blockers (a medication that lowers the blood pressure and slows the heart rate).
Chase now notices that Nadia has ammonia breath, which suggests kidney failure. This new information means the team needs to rethink their diagnoses again, and this time they come up with amyloidosis or an autoimmune disease (with Guillain-Barre, myositis, multiple sclerosis, polyarteritis nodosa, and SLE getting a shout out). She is started on steroids to treat the autoimmune disease and dialysis for the kidney failure. Things continue to deteriorate and Nadia develops shortness of breath and hives. It is determined that she is having a severe allergic reaction to the dialysis. Unfortunately, without dialysis, she’ll soon die. A kidney transplant is possible, but the waiting list is too long. Instead, the team decides to approach Elena who agrees to donate a kidney. The surgery is quickly performed and seems to go well at first, but then Nadia suffers a seizure while in the recovery room. And then the autoimmune tests all come back negative, so the suspected diagnosis was wrong. Now the differential diagnosis consists of acute porphyria or Factor V Leiden mutation (a condition that causes blood to clot more easily). House favors the latter, and Nadia is started on the blood thinner Heparin. Even with this treatment, Nadia is not doing any better, and is actually getting worse. She now has some uncontrollable movement of her left hand (chorea). Foreman suggests getting an MRI to look for a brain hemorrhage, but House wants a peripheral blood smear for acanthocytes (abnormally shaped red blood cells). Later, he comes in the room to talk to Nadia. He points out that she has obsessive compulsive disorder (OCD). Furthermore, he informs her that this and her other symptoms are due to a rare genetic condition known as McLeod’s Syndrome. Unfortunately, it is not curable, but it is controllable. After House leaves, Chase gives her a prescription for an SSRI ( — the class of drugs that includes Prozac, Zoloft, Paxil, Lexapro, and others) telling her that it will help with her OCD. As the episode end, she decides to try the medication in order to live a more normal life.
As usual, major complaints are in red, modest complaints are in blue, and nit-picking ones in green:
I don’t care if the donor was her sister, there’s no way that Nadia is going to get a kidney transplant without a firm diagnosis.
McLeod syndrome is an x-linked disorder. This means it is almost exclusively a male disease. Women with the affected gene are carriers, with mild symptoms at worst – however, their have a handful of cases of more severely affected women (felt to be due to unequal inactivation of the x chromosomes) but only one exhibited any symptoms near the level of disease Nadia was showing. Surely a good family history (she has that great memory after all) would turn up some siblings/cousins/uncles with neurological problems.
Nadia seems to have OCPD (obsessive compulsive personality disorder) more than OCD. Her symptoms seem more OCPD-like and ego syntonic than I would expect with OCD (and I consider it cheating for the writers to not even suggest such a major clue until the very end the way they did).
While people with hyperthymesia have been said to have some OCD-like characteristics, I’ve never seen it mentioned that they actually have OCD itself.
CK from the heart can easily be distinguished from CK from skeletal muscles or other sources.
McLeod’s will show up on an MRI, but then it’s not a “tumor” or “stroke” so I guess they didn’t look for it.
Before starting a blood thinner such as heparin you need some proof of blood clots, even if it’s just an elevated lab value (such as troponin or d-dimer). I guess you could argue that the elevated CK could have been CK-MB (the heart form of creatine kinase, and an elevated level can represent a heart attack) but then the heparin should have been started at the very beginning of the episode.
Levodopa is really never administered by itself anymore for Parkinson’s (too many side effects). It is prescribed in a combination form with carbidopa.
She was allergic to the hemodialysis, what about peritoneal dialysis?
Taub was always shown to be a plastic surgeon. Now he’s a pathologist too?
The medical mystery this week was barely intriguing and only got a little better as the episode went on. This is House, so you knew the hyperthymesia had to be a symptom: I give it aC. The final solution was a stretch, even by House standards. I give it a C-. The medicine was very sloppy and the sudden transplant was too much to believe: D+. The soap opera was pretty good, I liked that we saw more Wilson, and the Taub/Foreman pairing is always fun (I also liked the call back to video game episode); it earns a B+.
The review of the previous episode of House
A list of all prior House reviews
February 14th, 2011 at 11:24 pm
Maybe I misunderstood the show, or your comments, Dr. Scott – are you implying that Nadia *didn’t* have kidney failure and that the transplant was unneeded?
The premise of the episode reminded me of a wise old saying that’s been attributed to a variety of people, including Ingrid Bergman: “Happiness is good health and a bad memory.”
February 14th, 2011 at 11:30 pm
Official Comment
No, Nadia had kidney failure — but until you know the cause of the kidney failure — and that transplanting a kidney will actually solve the problem — then there’s no surgeon who would proceed and put two lives at risk. They needed proof, not “maybe it could be”
February 14th, 2011 at 11:36 pm
I don’t mean to belabor the point, Dr. Scott, but if Nadia had kidney failure, and she couldn’t undergo dialysis, what were her choices other than a too-hasty transplant?
February 14th, 2011 at 11:58 pm
Official Comment
If Nadia couldn’t undergo hemodialysis (or any other sort of dialysis), then her options are extremely limited, and the likely outcome is death. Not every condition is amenable to treatment. A transplant may offer some relief — but frankly I don’t think the risk/benefit evaluation supports it: it’s a major surgery with risk for both parties, it will have lifelong implications for the donor (no NSAIDs, for instance), and there’s no proof (at the point, anyway) that it will be anything other than a stopgap measure.
February 15th, 2011 at 12:18 am
Is it safe to give a patient blood thinners so soon after major surgery?
February 15th, 2011 at 12:25 am
Was the SSRI supposed to treat the COD? I thought they told the patient that it would just worsen her memory.
February 15th, 2011 at 12:26 am
That is not how you give insulin injections to a cat.
February 15th, 2011 at 12:32 am
Official Comment
Leon,
I know Orthopedists in our area keep patients on blood thinners for several days after surgery. I don’t know about kidney transplants. Heparin is readily reversible if required.
Memtest,
The SSRI was to treat the OCD, and the OCD was responsible for her memory, so the SSRI would worsen her memory.
February 15th, 2011 at 1:09 am
whether realistic or not the episode was entertaining, that’s what’s important…just saying. anyways great review
February 15th, 2011 at 1:37 am
Interestingly, I can tell you from first hand experience that SSRIs (Paroxetine) have dulled my memory. Nothing major, and I’ve always had a pretty good memory. (And, hey, forgetting where my keys are is certainly better than traumatic depression bordering on PTSD.
What I wanted to know was, you said that McLeod Syndrome is X-linked recessive, and thus almost never seen in women. I understand that this makes it a lot more common in men, but shouldn’t there be a significant number of women who have the full disease as well? (rather than just being carriers.)
There doesn’t seem to be anything that would prevent a man with McLeod Syndrome from fathering a child. Any daughter would automatically be a carrier, and thus, if the mother is also a McLeod syndrome carrier, wouldn’t any daughter have a 50% chance of being a carrier, and a 50% chance of having the full McLeod Syndrome?
February 15th, 2011 at 1:58 am
I recently had a transsphenoidal surgery to drain a cyst near my pituitary; they stuck me with heparin twice daily due to the fact I was bedridden while in the ICU. I questioned the necessity of this given my young age, but as you said it is a good precaution and reversible if needed.
February 15th, 2011 at 3:29 am
There is actually a patient like this who has perfect memory being studied at UC Irvine. I think it’s a pretty interesting case that could open up some doors towards understanding memory a bit better. Just thought I’d mention it in case anyone cared to look it up =P
February 15th, 2011 at 4:30 am
I actually liked this episode much better than a lot of the previous ones. More drama, less soap. (this seemed a less fluffy episode at least).
One for the nitpicks: At the beginning of the episode Foreman seemed to be checking her heart rate while feeling somewhere behind her ear… (and he found it there too!)
February 15th, 2011 at 6:14 am
The x in the X chromosome is all caps, as X-linked disease, etc. I give you a C- in Genetics. :-)
February 15th, 2011 at 6:47 am
As soon as I saw this episode I came straight to this blog thingy as I remembered seeing you review them before- mainly because I have OCD and had never seen it diagnosed as a symptom, or caused by, a physical disease before and wondered whether this was real or just House-writer-logic. Thanks for clearing it up!
The cat thing saved the episode for me. The House Wilson relationship is one of the main reasons I still watch House.
February 15th, 2011 at 7:40 am
Yeah, I had a big problem with the kidney transplant ‘on spec’, as it were…has anyone counted the number of kidney failures so far in this season? The writers are aware of the other organs, yes? And I was glad to see we are back to every patient having seizures again.
February 15th, 2011 at 8:04 am
Apparently hyperthymesia was invented to describe the total recall of the woman Jay mentions above. Reading descriptions of her feats, though, it sounds as if what she has is an eidetic memory, and she read the newspaper every day. Her memory is for the kind of thing you would read in the paper–including the weather and the first day of school–and she is just very good at associating the dates with the stories and also with events in her personal life. The Wikipedia article on hyperthymesia lists other people who have had it. It must be a peculiar affliction.
I liked the Nadia story and I wish they had locked into it a bit more intensely instead of spinning off the stories about Taub’s test and Wilson’s cat, which have nothing to do with the case though they do with the theme of memory.
February 15th, 2011 at 8:12 am
lainey – these are medical reviews assessing the realism and medical problems of episodes.
February 15th, 2011 at 8:12 am
Official Comment
Pentalarc,
As I understand it, McLeod’s is a rare enough disease that encountering a woman with the full disease has not been an issue. (It may also be a situation where a male with the full blown disease is less likely to have children and pass on the genes — but, on the other hand, with an average age of onset of 40, you’d think they’d have kids by then).
February 15th, 2011 at 8:51 am
Did I mention already I barely scratched a C in genetics? No? Well I did so giving my opinion on a genetic solution I know nothing about is pretty much pointless. However I did liked the medicine here because it pocessed something that was completely missing in previous episodes: linearity. DDx’s were mostly logical, ideas were not out of the blue and the treatments were logical and made sence as well (except for the kidney transplant but that is not a first time thing: in “Sleeping dogs lie” they did a live donor liver transplant whitout a diagnosis because they needed the time to figure it out. It was a major problem back there and needed Cuddy involvment: but the writers probably decided it would be boring to delve into the ethically impossible stuff they usually entertain us with.)
Apart from that I was happy to see some things done right for a change. For example I cannot believe Omar Epps managed to say “wide complex tachycardia” and than (correctly!) reached for the paddles. Golden star for the writers for taking critics by heart. BTW how come nobody did not notice that she developed an allergic reaction WHILE being on steroids (for her supposed autoimmune condition) :). Major nitpick and screw up for the writers! The kidney failure was badly handled as well: they seemd to not understand the difference (again!) between different types of kidney problems: chronic kidney failure could be caused by autoimmune conditions but that would meen that she would present herself with bad kidney vitals form the very begining: not devepol kidney problems midway through the episode. She had hemolitic uremic problems due to the abnormal erithrocites: how come nobody noticed that while doing her blood work?
The drama/soap part was very well handled mostly due to Wilson of course :) I never tire from that guy! The fact that he got a cat to deal with his lonelyness the fact that he freezed and chocked when presented with a double D gift just out of nowhere, was sooooo Wilson! SPL great! The other subplot wiht Taub and Foreman was also well done – and made believable by the great acting from the two not so young (anymore) guns. Taub is becoming more and more my favorite fellow (right after Chase) adn he even managed to make Foreman funny! Bravo to PJ as well. All in all it was a light and funny episode in the old House spirit and I enjoyed it thoroughly!
“Barman! Champagne for everybody!” See ya! (guess who’s paynig :):):) House classic
February 15th, 2011 at 9:04 am
This is a book that came out a few years ago:
http://www.amazon.com/Woman-Cant-Forget-Extraordinary-Science–/dp/1416561773/ref=sr_1_1?ie=UTF8&qid=1297772896&sr=8-1
From what I’ve seen, it was the first thing to stir up interest in this “superior autobiographical memory.” I think there was a 60 Minutes episode about Jill Price, as well, and they featured another man who is a radio host who uses his memory as a gimmick for his job.
This is a clip from The View last month:
http://www.youtube.com/watch?v=1urVnHc5yHM
They interview three more people and, though it’s not that detailed, the guests give some sense of how their memories work for them.
I got the impression, from some bit of dialogue in a commercial or description of this episode, that the curve ball in the conclusion was going to be, “It’s your memory or your life.” Like, the treatment for her disease would limit her memory, or, possible but less likely, she would have some illness that would eventually destroy her memory. I felt like they finally got around to this inevitable ending in the clumsiest way possible. This type of memory is so intense, I don’t think it could possibly be eliminated through treatment for anxiety.
February 15th, 2011 at 9:15 am
My enthusiastic ranting about the more mellow moments of this episode made me miss and forget a point that actually thrilled me the most – seeing M3 drown into her own rightousness. After being masterfully set up by younger prettier House (let’s call him Chase :) she was forced to eat her “rules” Yeas she will lear the hard way that liing for the right reason is better than telling the truth for the wrong one. Oh how happy I was to see her chocking for words!
February 15th, 2011 at 9:17 am
Anybody catch Taub’s “Mod Squad” line to Foreman? Omar Epps was in the (not well received) 1999 movie version of the 60’s TV show.
Why do most of the patients on “House” seem to get private rooms? I was hospitalized three times in 2009, and each time, I was in a semi-private room. The last time I had no roommate, so it felt like a private room. I would think that most insurance would cover only a semi-private room.
February 15th, 2011 at 9:58 am
Is it possible for someone to have a memory like that, from any cause?
February 15th, 2011 at 10:05 am
Official Comment
lyxosus,
There have been five (or six, depending on your source) recorded cases of hyperthymesia. It’s interesting to note that these individuals do not have a photographic memory per se — it’s entirely personal. They can perfectly remember what happens to them directly, but are not above average at other memorization tasks.
February 15th, 2011 at 10:34 am
The 60 minutes show featured 5 people I believe. One of them was the actress MariLou Henner of “Taxi” fame. As you would expect, their feelings about having such memories were mixed due to the fact that you remember the bad with the good and you can’t shut it off. They examined their brains and did find differences from the norm but I can’t recall (ironic!) what they were specifically.
February 15th, 2011 at 11:26 am
Without doubt, one of the transplant medicine in this episode is the worst I’ve ever seen on House… Dissapointing
February 15th, 2011 at 12:45 pm
[...] House – Episode 12 (Season 7): “You Must Remember This” (politedissent.com) [...]
February 15th, 2011 at 1:15 pm
This episode may have been bad medicine, but it was good television. It deepened the characterizations of Taub and Foreman, and opened up possibilities for a new “buddy” relationship to contrast with House/Wilson. It sharpened the ethical complexities for M3 while showing her strength at shrugging that off Houselike and continuing to function at a high level with barely a pause. (Imagine Cameron doing that!) Glib, funny quips flew like paintballs (How was Java the Slut? Isn’t there a river nearby?). House’s acceptance of Taub and respect for M3 revealed his budding humanity. The team is again functioning like one. This overripe show may still have some legs.
February 15th, 2011 at 2:05 pm
I must admit that I appreciated the Ebola reference. Scott: Do I get a point for that one liner?
February 15th, 2011 at 2:19 pm
Props, Dr. R. You DID call that one last week!
February 15th, 2011 at 4:19 pm
Scott,
I’d like to leave a comment about the “OCD” part, because that’s where I feel I’m most knowledgeable.
While I’m no doctor, I’ve been diagnosed with OCD by two different psychatrists. Thankfully, I was treated by taking 200(!) mg of Zoloft daily, which was the max, and also an SSRI (though the increase came gradually).
In my case, my OCD was compulsive sun avoidance. I had a relative die from what turned out to be skin cancer (malignant melanoma). I then gradually developed a fear of UVA rays, started with using sunblock (50 SPF) at increasing daily intervals all the way to complete outdoor activity avoidance and even quitting my job to take a nightjob. All the while I kept obsessively scanning my body for moles. In fact, it got so bad at one point that I actually thought about using MBEH (topical cream for vitiligo universalis patients ) to kill off the melanocytes! Yes, it was *that* bad.
While it’s true that OCD is egodystonic, the problem comes from the fact when you believe your obsession is actually justified – and to a great degree, in my case at least – it was, and still is. One of the fundamental differences between OCPD and OCD is OCPD tends to be generalised, not very stressful and is incorporated into the usual daily routine. OCD, however, can be extremely overwhelming and is actually the other way around – you completely change your routine and lifestyle to adjust them to your OCD. Why do you think Nadia has moved, works as a waitress and avoids contact with her family/friends? Because they trigger her OCD – in this case, bad memories.
There are many reasons why it might appear egosynstonic in Nadia case:
1. Lack of understanding of what OCD really is. Most of us (non-doctors, obviously) have a stereotyped and superficial understanding of OCD (we actually think of “OCPD,” i.e. obsession with perfectionism and attention to detail). So yes, she knew what OCD stands for, but she might not have known what it REALLY is.
2. Nadia’s lifestyle change and relocation put a stop to all her OCD triggers, and is thus no longer stressful.
3. Memory retention is possibly an evolved by-product of a self-defense mechanism that came with her OCD (eidetic memory CAN be developed over time). She wants to justify hating her sister and family, so she tries to remember everything, or maybe a paranoia that her loved ones try to kill her (she insisted her sister drove into her when she was a kid, even though the sister insisted it was an accident) so she needs to keep track of everything they do to “justify” her paranoia. Though on the other hand, OCD people do have a problem with non-verbal memory, but Nadia’s OCD requires her to keep track of every thing her family did.
4. I can relate to Nadia’s reluctance to take the SSRI. While it’s true that she might “lose” (emphasis on quotation marks) her special ability, it could also mean that by treating her OCD, she might start to “let her guard down.” (I had the same issue, but good thing that it became a “habit” as opposed to an obsession, my skin will thank me in a few decades :))
Again, I could be wrong, or maybe I’m bias (most likely am). And the verbosity? That’s just my Asperger’s talking :)
February 15th, 2011 at 4:54 pm
I was going to cry foul if you gave the “soap opera” anything less than a B, because I loved this episode, in spite of perhaps the most unlikable patient in recent memory. Everyone seemed to be hitting on all cylinders. The old-school “House trying to figure out what Wilson desperately wants to hide” worked as it always does. We saw some real character development for Masters starting when Chase talked her into instigating the fight between the sisters. And for perhaps the first time ever, I actually found myself caring about Taub. I don’t think I’m the target demographic for him – his age was given as 45 in this episode, almost twice mine. But the “I can’t fail at yet another important thing” scene got to me. The cheating was a typical “House” resolution, but I dig the budding bromance between Foreman and Taub. Certainly, as a fellow gamer, that scene clicked with me (though why in the world was Foreman’s Xbox on its side? Isn’t that just asking for it to tip over and become badly damaged?) Even Cuddy seemed quite on, for the little screen time she had. I definitely enjoy those scenes with her and House together…let’s just say the more I see of Lisa Edelstein the better ;) This episode also made impeccable use of an open ending – Chase handing the pills to the patient that will cure the OCD/take away her perfect recall. That’s the perfect sort thing to leave up in the air for the viewer to decide. Personally, I can’t imagine she takes the pills. Her identity is too closely tied to her memory, for better or worse. It’d destroy who she knows herself to be. And I also thought it was neat that something that was highlighted at the beginning of the episode actually did play a part in the final diagnosis (there was a one or two-second pan over the framed jigsaw puzzles in the apartment search). Reminded me of the ridiculous typewriter ribbon earlier in the season.
So, unfortunate that the medicine stunk, but all in all this was probably my favorite episode of the season so far. Hope it wasn’t totally ruined for you medical types who follow along with the medicine like Dr. Scott.
February 15th, 2011 at 5:01 pm
This is the first comment I’ve left this season. Indeed, it’s my first visit to the site this season so I didn’t read last week’s comments.
Ignoring the medicine, this was full of much, much better dialog. Even Nancy Drew Masters got under my skin for a reason this week.
After last week’s bore-fest with a diagnosis even I, a lay person, came up with, this was much needed relief.
Last week was as bad an episode as I can recall and I’ve been an avid fan since Season 1.
February 15th, 2011 at 5:02 pm
Oh yeah…and DO kidneys really look like a Bavarian Weisswurst like the one in the show?
February 15th, 2011 at 5:35 pm
@Terrence: Not to impugn your disease or anything, but did you every consider a good 50,000 watt jolt? ECT has come a long way since “Cockoo’s Nest” and has been very effective in treating OCD.
February 15th, 2011 at 6:40 pm
There was a fantastic article in Wired Magazine a while ago about a woman with a memory just like this. It’s a bit long, but it’s worth a read:
http://www.wired.com/medtech/health/magazine/17-04/ff_perfectmemory
February 15th, 2011 at 7:22 pm
I’m surprised that Scott or none of the other docs who post here didn’t remark on Taub’s cheating on his test. I found it kinda remarkable that a man of his intelligence couldn’t pass.
I was put on Heparin right after kidney surgery because of blood clots. Turned my urine red but the docs were way more worried about the clots.
February 15th, 2011 at 8:00 pm
Again, thanks for the review!
Again, I’m a horribly uneducated person regarding medicine, so I cannot say anything remotely relevant or helpful or interesting concerning that topic.
Still, I only wanted to say that they referenced the video game introduced in “Epic Fail” once in another episode. Unfortunately cannot remember which episode that was.
Oh, by the way, I loved Wilson hysterically reaching for the pan! And the thing about the armpits! You are right, Wilson needs to get more screen time! :D
Keep up your brilliant reviews!
Regards
February 15th, 2011 at 9:18 pm
If she was allergic to the filter for dialysis, then they could have tried another type of filter made with different material. There are at least 3 different types of filter made (because I’ve used all 3 in the dialysis clinic). We even had a gentleman once who was allergic to all 3 and we had to ship his special from Japan.
Also I think peritoneal would have worked in her case too, and it’s gentler on the system.
February 15th, 2011 at 9:34 pm
HouseIsMyVicodin : The episode was “Now What” the season seven premier.
February 15th, 2011 at 9:34 pm
oops, wrong homophone
February 15th, 2011 at 10:18 pm
Wait, so:
Does McLeod’s cause OCD, which caused Nadia’s memory?
Or were the OCD and McLeod’s separate, but the OCD still caused her memory?
I personally refuse to believe that OCD can make your memory that good. I mean, the woman remembered EVERYTHING; she wasn’t just storing up memories involving her sister doing her wrong, she could remember the exact number and circumstances of the times she fell during any given year. OCD can make you TRY to remember everything, but if your brain isn’t already wired all freaky to give you perfect memory, a lot of it will still slip.
Luckily, there was the very, very good soap opera this week to redeem.
February 15th, 2011 at 10:41 pm
@HCH Clearly you’ve done it yourself at one point..
February 15th, 2011 at 10:48 pm
For the last few years of my grandpa’s life he was using peritoneal dialysis, which is the first thing I thought about when her dialysis was causing an allergy. I can’t imagine someone being allergic to a dextrose solution…
February 15th, 2011 at 11:33 pm
I have CDO. It’s like OCD except the letters are in alphabetical order LIKE THEY SHOULD BE!
February 16th, 2011 at 12:22 am
Back at Terrence: I have. Its awesome!
February 16th, 2011 at 12:31 am
Since when does a Doc have to “retest” for Board Certification? I thought they just had to send in a check every year or two, along with CME’s. Also, exactly at what age did Taub graduate from medical school? Plastic Surgery residency is 7 years (assuming he’s also a Board Certified General Surgeon, which most are) and a pathology residency is probably at least 2 to 3 years. He’s been with House 3 years, plus roughly 5 years with his surgical practice, adding in the 10 years of both residencies. He would’ve had to have been about 20 years old; a boy genius for sure. Certainly smarter than House.
February 16th, 2011 at 12:37 am
Official Comment
I can’t speak for Pathology or Plastic Surgery, but as for Family Practice, we have to recertify every 7 years (10 if you meet certain criteria). To recertify, in addition to meeting yearly CME requirements, you have to retake and pass the Family Practice Boards. As far as I know, all other specialties have similar requirements, some slightly more lenient, some slightly stricter.
February 16th, 2011 at 4:32 am
Just reading the Wired story on Jill Price – almost seems as if she was the template for the POTW:
“Lost in all the hype is an inconvenient fact: Price’s brain was scanned more than two years ago, and the results—not yet published—apparently don’t support the notion that she’s some kind of memory goddess. Her hippocampus and prefrontal cortex are reportedly normal. The one significant aberration, according to Price—who was told about the scans by doctors who won’t discuss them publicly—is that her brain resembles those of people with obsessive-compulsive disorder.”
February 16th, 2011 at 6:44 am
Cardio surgery and infectious disease are similar
February 16th, 2011 at 8:17 am
“(and I consider it cheating for the writers to not even suggest such a major clue until the very end the way they did).”
Couldn’t the opening scene where Nadia was aggressively insistent that the woman had been to the diner before be OCD behavior? She wasn’t shown to have had any issues with social interactions, ie not being able to recognize the woman obviously didn’t want to be remembered.
Also, that cat was gorgeous. I kind of hate House for his anti-cat rhetoric up to and including leaving a window open?! (Though the intervention scene was hilarious.) More power to cat-loving Wilson!
February 16th, 2011 at 10:49 am
http://www.youtube.com/watch?v=935vOt6lGgY&feature=player_embedded
As you can see from the above, Hugh Laurie has actually worked with this particular cat before in the Stuart Little movies. In fact, if you listen carefully to the scene in which House holds the cat, you can hear the kitty purring. I gather he (the cat is actually a male called Rocky) purred so loudly that it became a problem!
February 16th, 2011 at 3:52 pm
Best line in the episode:
Is the mouse poisoned?
LOL
February 16th, 2011 at 6:24 pm
Scott,
Though it’s outside my scope, I’m not sure I agree that you need a diagnosis for a living donor transplant. I thought the litmus test was simply if the donor is shown to understand the risks? I almost donated a partial liver. And assume a diagnosis is needed, the patient might not get one in time. I would sue if that ever happened to me!
February 16th, 2011 at 8:04 pm
@HCH Imagine my shock (no pun intended)
February 16th, 2011 at 10:02 pm
Nice review as always
That “oh, she is allergic to dialysis, let’s give her a kidney transplant from a relative now” felt all messed up. Ever for someone like me, who doesn’t know anything about medicine, but that defies common sense…come on, at that point they didn’t even have a clue on what was wrong with her!
Besides that i quite enjoyed having Wilson back and all the cat stuff. And naming a cat “Sarah”…gimme a break!
February 16th, 2011 at 11:18 pm
I can’t help but wonder if the writers swiped the “Kevin Spacey is Keyser Soze” line from the “You Don’t Know Jack: Movie ending-phone”. I laughed so hard I completely missed the next 30 seconds of dialog.
February 17th, 2011 at 5:14 am
They had a Dell Latitude XT on their mobile IV :)
February 17th, 2011 at 9:12 am
Did anyone else catch the name of the energy drink Taub was drinking during his all-nighter with Foreman – “ONS”? A play on “NOS”, sure, but the name’s doubly clever given Taub’s penchant for One Night Stands. :)
February 17th, 2011 at 4:09 pm
@melly ~ the Usual Suspects reference is a nod to Bryan Singer (a House EP) who directed that movie. The show has referenced Keyser Soze before in season 5 – Joy to the World – when House teases Wilson in the cafeteria about the Keyser Soze identity plot twist.
February 17th, 2011 at 4:12 pm
Besides any medicine, I liked the music in the bar scene pretty much. Can anyone tell me who was performing that song?
Thanks in advance
Chris
February 17th, 2011 at 5:17 pm
Felicia by The Constellations
February 18th, 2011 at 4:08 am
@Devils Ad
Thanks for your help. I love that song.
February 19th, 2011 at 3:55 pm
I wonder if the Foreman Taub friendship is being set up for a future serious conflict. I could see the FBI catching Foreman’s license plate when he drove Taub to buy the cheat sheet from a guy who was under surveillance and having to testify against Taub or face charges himself.
February 20th, 2011 at 8:06 am
Would levadopa really have been so quickly and with so little evidence?
February 20th, 2011 at 9:05 am
Scott: I noticed that you calculated the Challenge scores, but haven’t posted them yet
February 20th, 2011 at 11:36 am
Official Comment
It’s posted, I just haven’t put the link to it on the House post yet. It should always be the post chronologically just before the episode it covers.
February 20th, 2011 at 11:46 am
Ok, thamks
February 20th, 2011 at 8:16 pm
IDK if you care, but Ledasmom is absolutely right: that is *not* how you give an insulin injection to a cat!
http://www.cathealth.com/InsulinInjectionProced.htm
February 22nd, 2011 at 6:28 pm
Think the hyperthymesia related to OCD is due to the original article on hyperthymesia, where the patient AJ is described as having many OCD-like characteristics including obsessively reflecting on her memories.
http://www.informaworld.com/smpp/section?content=a741907726&fulltext=713240928
February 23rd, 2011 at 12:26 am
Couldn’t ammonia breath also be a sign of liver failure (as it was in Both Sides Now)? There could be other reasons, but it looked liked Masters just diagnosed it as kidney failure after Chase was like “come smell this.”
Heparin isn’t vegan. Although I suppose that it doesn’t matter too much if 1) you’re just eating vegan to lose weight (although fat vegans exist), 2) you’re gonna die without heparin, or 3) both. ;)
February 25th, 2011 at 5:12 pm
I sent the Wiki liink to my own only sister…I am the elder , Elena, and she is Lori….but I was the one with photographic memory at times in childhood and thank God for my good Libra Father who insisted on a happy work/love balance and saved me from OCD and possible megalomania…happy wife and mother and even date once I got over the bereavement and my work’s been at the White House, but I often wondered if my gifted student status had been played more, what the outcome might have been. I do fine in study updates and made my site and keep it up. I never ran over my sister though… precious and good and fun….I did give her a funnyhaircut once, very Freudian slip :-D
Every 20 years we have a fight then do ok.
We are good, the fight makes me cry.
Thanksomuch for the story! Food for thought on several points.
February 26th, 2011 at 4:51 am
Not a medical-related trivia:
I really appreciate two references to two other tv shows i like:
Lost (explicit ‘the button to press in Lost’)
How I Met Your Mother (the Intervention!)
February 27th, 2011 at 1:57 am
This story is definitely based on a waitress with “perfect” memory whose descriptions of it and her fear of forgetting struck me as very OCD when I read about it as a teen.
The ragweed moment was moronic. The new bromance was cool and the kind of perk the show needs. I want M3 to die in a fire.
February 28th, 2011 at 5:15 pm
My God, how pathetic do they want Taub to become? Unable to face a test he once aced, he resorts to cheating — in other words, he fails miserably. Maybe he should eat a bullet like Kutner did.
March 1st, 2011 at 11:02 am
True, for X-linked genetic disorders males are affected far more often than females. Affected females usually then would have an affected father, and a mother who was a carrier. Some mutations are incompletely ‘penetrant’ so conceivably dad could have been an unaffected ‘carrier’. Skewed X-inactivation is believed to be the culprit for female affecteds in many cases. A less common but perfectly plausible alternative is that mom was a carrier, and the second mutation arose in the dad’s germ line only, so dad himself was not mutated in most of the cells in his body. New mutation rates are high enough that this does happen, rarely but that’s exactly the kind of thing House would be called in for. However, it does seem like the patient’s symptoms were not a very close match for the known clinical presentation of this disorder (which I’d never heard of before, even being a geneticist).
March 1st, 2011 at 11:23 am
[...] House – Episode 12 (Season 7): “You Must Remember This” (politedissent.com) Last night’s episode left [...]
March 20th, 2011 at 10:45 pm
Okay, I know a lot of water has passed under the bridge since this episode, but I have one major quarrel with the OCD medication. It is absolutely irresponsible for anyone who is not a psychiatrist to write a prescription for a psychoactive medication and then send that patient out the door. Especially when you are talking about SSRIs.
In a significant proportion of OCD patients, SSRIs actually exacerbate the OCD and can also be disinhibiting, which would give Nadia the worst of both worlds. It MAY mess up her perfect (but apparently selective, unhappy, miserable, and paranoid) autobiographical memory (I mean, no memory of the Perfect Cookie? Or her First Taste of Cotton Candy?), but it may also make her problems with conflict even worse.
OCD isn’t just about lining up your shoes by color or avoiding germs. OCD patients have paralyzing anxiety that is unconnected to the rituals, intrusive thoughts, frightening compulsions and general misery. So by giving her an SSRI, they don’t know whether they are going to make her better, or horribly, horribly, cripplingly worse.
I have seen SSRIs cause trichotillomania (a symptom of OCD, and not a dx in its own right) in an OCD child, and drive another one to compulsive hoarding of an everyday object and the an a suicide attempt. The less-risky alternative is to have a psych consult in the hospital, and try her on something more benign, like a mood stabilizer.MS have a documented ability to calm the symptoms of OCD that include the ruminations, the anxiety, and the intrusive thoughts that also accompany OCD. (It’s not just lining up your shoes by color!) The MS might even make her thinking sharper. She might be able to keep her memory and be happier, too.
March 21st, 2011 at 7:12 pm
Sorry I didn’t read all the comments so I don’t know if this was mentioned or not… And it’s more a psychological matter than a purely medical one but….
Anyone think that the writers chose to use a female character when the disease is more than predominantly male just so they could have her be more emotional and irrational and maybe a little hysterical at times? Pigs. lol
Well at least she wasn’t a typical Hollywood looker to boot!
March 28th, 2011 at 12:47 am
Just my two cents… it itches my pedantic center when you seem to discard an x-linked disease in a female. X inactivation is *not* the only way such a disease could be felt – it could be directly inherited. Dad would have to have it, yes, and the chance is slimmer, but House specialises in the odd. And (unless they mentioned otherwise, I haven’t watched this episode yet I don’t think, but being horribly behind anyway I don’t mind spoilers :P) maybe dad died of something else before becoming symptomatic too, which would explain her not knowing.
Yes the chance is slim, but not, I think, quite the practical-impossibility you seem to suggest it is each time it comes up.
Not a huge criticism or anything, mind, just scratching an itch.
March 28th, 2011 at 10:12 am
This episode left me unable to empathise with House in any way whatsoever. Anything from now on will be me watching to hope for the worst.
October 17th, 2011 at 3:43 pm
I’ve just watched the episode, and while the hyperthymesia was clever, I have some medical concerns:
1: The OCD led to the hyperthymesia? And BOTH are cured by SSRI? I don’t see why OCD would lead to hyperthymesia or for that matter why SSRIs would lead to memory loss – in fact, why we need memory loss at all. I suspect it ain’t that easy to cure hyperthymesia, let alone with SSRIs.
2: Again, “relative=compatible”
3: In the Italian version, House said that the patient sees everything in an objective way thanks to hyperthymesia. Why should it?
4. I am annoyed that the writers just can’t go and search for more male or child actors. It’s far from the first time the gender/age of the POTW is at odds with the diagnosis-
I am interested to see what is said here.
Leave a Reply
Contact Me
About
Subscribe:
The Best Of...
Special Topics
Archives
Categories
Twitter
See Also
Comic Blogs
Medical/Science Blogs
Currently Reading
Arbitrarily Interesting Medical Condition
Syndrome
The Net:
Contents may have settled during shipping. Past results are no guarantee of future performance. No animals were harmed during the production of this product. Void where prohibited by law. All rights reserved. Not valid with other offers or specials. Professional driver on a closed track. Your financial institution may impose other fees. All models are over 18 years of age. Employees must wash hands before returning to work. Results not typical. Many suitcases look alike. 18% gratuity added to tables of six or more.
Do not taunt Happy Fun Ball.
© 2004-2012 Polite Dissent. Powered by WordPress