Polite Dissent

More than once, I’ve pointed out when a penciler takes a little artistic license and draws extraneous IV lines, tubes, and wires in hospital scenes.

This cover, however, takes to a new ridiculous extreme. Exactly how many tubes and wires does John Lynch need?

cover from Team 7 #2, art by Aron Wiesenfeld

There are days when a gorilla practicing medicine makes as much sense as anything else.

Uncanny X-Men #512
Matt Fraction, writer
Yanick Paquette, penciler

Beast and his team of scientists have traveled back in time to the San Francisco of 1906 looking for Nicola and Catherine Bradley. They find Catherine just in time to rescue her from an attack by goons from the Hellfire Club — immediately afterward, Catherine Bradley suffers some significant vaginal bleeding. The doctor who examines her diagnoses her with placenta previa and places her on bedrest.

Placenta previa occurs when the placenta, instead of its normal location along the side or top of the uterus, implants along the bottom of the uterus, covering up the opening to the birth canal. It is a fairly common cause of vaginal bleeding during later pregnancy, but is very, very rare in the first trimester (the first three months of pregnancy).

More common causes of first trimester bleeding include implantation bleeding, miscarriage or threatened miscarriage, or an ectopic pregnancy. Trauma can play a role as well, as can non-uterine causes of vaginal bleeding.

There is nothing a physician or mother can do to cure placenta previa. Minimizing the recurrence of bleeding from the previa is wise, so that is why bed rest is recommended. Luckily, most placenta previa resolve by themselves — as the uterus grows during pregnancy, it pulls the placenta up higher. For a placenta previa discovered during the second trimester, there is a 90% chance it will resolve by the delivery date.

Currently, a cesarean (c-section) is the preferred method in the United States for delivering the baby when there is placenta previa. If c-section is not an option — for instance, in certain more remote parts of the world, or at the turn of the 20th century — the baby can be delivered vaginally, but it is a bloody mess. While there is a risk the mother may die due to placenta previa, it is the baby who faces the greatest risk of death. Currently in the United States, the maternal mortality rate from placenta previa is 0.03% (I don’t have the data, but I suspect the risk was several orders of magnitude larger in 1906).

(And whatever happened to that Cambodian psychic, X’ing X’iang? As of the last issue of the final Team 7 mini-series, she was imprisoned within the Internal Operations building. Is she still there?)

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed team 7 chuck dixon

from Adventure Comics #191 (August 1953)

Just look how far we’ve come with regards to polio in the past 56 years.

Today’s example of bad comic book CPR comes from Superman/Supergirl: Maelstrom #3. In this scene, Superman and Supergirl are on a “family bonding” camping trip to a planet under a red sun. While there, Superman breaks his arm and then falls into a river and nearly drowns before Supergirl rescues him.

Superman/Supergirl: Maelstrom #3 by Justin Gray, Jimmy Palmiotti, and Phil Noto

Another example of the straddle-the-chest style of CPR seen in comics — definitely not the recommended position in real life.

You’ll notice that Supergirl is giving rescue breaths. As I mentioned yesterday, rescue breathing is no longer recommended for most CPR situations, but this is a near drowning scenario — one of the instances when rescue breathing is still recommended.
But how can she give rescue breaths as shown when she’s sitting on his chest?
And to really nit-pick, she needs to tilt his head back to open the airway better. And keep her arms straight when giving compressions.

On the other hand, we know that Superman has some bizarre internal anatomy, so maybe this is Kryptonian style CPR…

After last week’s brief discussion of CPR¹, I felt it would be a good time to look at CPR as practiced in a variety of comic books. First up, DV8 #3 (1996), by Warren Ellis² and Michael Lopez.

Evo and Frostbite stumble across the body of a young woman who has suffered a drug overdose. They proceed to CPR.

Evo is shown using a sit-on-top-of-the-patient style, as opposed to the correct off-to-the-side style. I don’t know why he’s chosen this stance, but it’s going to make it more difficult to move the patient and I suspect it will restrict some of the blood flow to the legs. It would also be a bad idea during a code blue because those femoral veins and arteries he’s blocking are good places get vascular access (plus it’s mighty hard to balance like that on a hospital gurney).

I have absolutely no idea what Frostbite is doing with the patient’s arms, unless he’s trying to use an older and for-good-reason forgotten resuscitation techniques. Whatever he’s doing seems to make her sleeves appear and disappear though.

Even though rescue breathing is no longer recommended for standard CPR, it was when this book was published, so it’s unusual that Evo and Frostbite are ignoring it — especially since they remarked earlier that she is suffering from respiratory arrest.

Successful resuscitation? Yes (though they then leave the scene, leaving the patient alone to suffer the other potentially fatal effects of her drug overdose. After all, the drug is still in her system.)

NOTES:
1. What I’ve read suggests CPR as we know it was developed in the late ’50s and early ’60s, but not taught to the public until the early ’70s. I’d like to think the Avengers would be ahead of the curve and trained in CPR by Iron Man #18. In 2008, it was switched to a chest compression only style.

2. Yes, Ellis is British, and they may have CPR taught slightly differently there, but DV8 takes place in the US, so I’m going to hold him accountable for the standard American Heart Association CPR.

Ultimate Wolverine Vs Hulk #6
Damon Lindelof, writer
Leinil Francis Yu, artist

Wolverine doesn’t seem to have a very good grasp of anatomy. It is anatomically impossible for Wolverine to injure She-Hulk the way he’s suggesting.

I’ve included a couple of anotated images to demonstrate. Wolverine has one claw in her spleen (left side of her abdomen), a second claw in her left kidney (far left part of her abdomen), and threatens to put the claw in between them in her liver — which is found on the right side of her abdomen.

As for the rest of Wolverine’s threat: he’s right, injuries to the spleen bleed, and they bleed a lot — after all, the spleen is basically just a blood-filled sponge. On the other hand, a puncture wound to the kidney will cause some damage, but as long as the renal blood vessels and the ureter aren’t damaged, it’ll continue to function (plus, as he points out, she’s got a second one). Similarly, a puncture wound of the liver would bleed, but not as much as the spleen. More importantly, Wolverine seems to be forgetting that She-Hulk has a healing factor — just a few issues before she jumped out of a supersonic jet without a parachute and survived. She’ll survive two or three claws.

For a place that was also supposed to be a school, the Xavier Institute for Gifted Youngsters doesn’t seem to have done a very good job of actually teaching — or at least teaching chemistry — for Magma to think that purely physical processes like erosion and grinding could break molecular bonds.

Though to be fair, Magma also spent some time at Emma Frost’s Massachusetts Academy, so maybe they did an equally poor job of teaching there as well.

Or you could just use CPR.

It’s the first thing you should try to get a “stilled heart” to beat again (and this is at least a decade before AEDs were available).

So, CPR. Right now.

Seriously, if you’re going to whisk Tony Stark away to the Avengers Mansion to play guinea pig for the Ultra-Rejuvenator , at least give him CPR in the meantime to keep the blood circulating — especially to the brain.

‘Remember how I mentioned that there were two New Teen Titans anti-drug PSA comics from the ’80s? It turns out I was wrong: there were three.

Jesse, trying to emulate his older brother Dave, has started to use drugs. After he shares some angel dust-laced marijuana with his friends, he heads off to an anti-drug rally his parents are making him attend. The Teen Titans (minus Robin, who is once again replaced by generic hero “The Protector”) are speaking at the rally — no, not Speedy, he’s probably back at Titan’s Tower getting high.

When the Teen Titans tell the audience that drugs are bad, and his parents chime in to support the Titans, Jesse throws a tantrum and runs out of the meeting in a huff. Beast Boy tails him, just to make sure he doesn’t get into any trouble and — wouldn’t you know it — there’s a tall cliff in the middle of town that Jesse almost tumbles over. Beast Boy turns into a rhinoceros and stops him from falling off the edge. At just that moment, the drugs Jesse’s been taking cause severe stomach pains, and Jesse falls off the cliff despite the presence of a green pachyderm. Luckily, Raven’s soul-self swoops by and saves him, but not before her empathic powers absorb the hallucinatory effects of the drugs and Raven begins to Freak Out. The other Titans are able to subdue her and they cart her off to the hospital. Seeing the effects of the drugs on Raven, Jesse swears never to use drugs again.

The Teen Titans now turn their attention to Jesse’s supplier: his older brother Dave. They track him down to an old abandoned shack at the end of town (where despite begging his supplier for a hit the page before, he’s now handing out drugs to half a dozen kids – for free). A brief skirmish ensues and Dave escapes , but that was really the plan all along. The Titans now follow him to his supplier. A bigger skirmish follows and the Teen Titans are able to capture the entire drug dealing gang. Furthermore, both Jesse and Dave have sworn off drugs for good.

Like the previous Teen Titan anti-drug comics, this one starts with a letter from Nancy Reagan. Several pages of confidence building and decision making exercises are included at the end of the comic. Unlike previous comics, this one is sponsored by IBM, so I’m not clear why Robin was replaced by the Protector, as I understood that was due to Nabisco/Keebler rivalries. The story is by Marv Wolfman and Joey Cavalieri with capable pencils by Adrian Gonzales.

More PSAs

Tags: comics medicine psa teen titans

I’m pretty sure the various Team 7 mini-series have more psychic nosebleeds per issue than any other series I’ve encountered.

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed grifter team 7 chuck dixon

ad from Action Comics #171 (October 1952)

Polio was once considered a common enough disease that warnings were printed inside comic books. In recent years, thanks to vaccination, polio has been a thing of the past in the United States. Unfortunately, thanks to the ill-informed and ill-used anti-vaccine movement, childhood diseases once thought vanquished are reemerging into the population. How long until we see ads like this again?

1. He’s been in the hospital for nearly a week, his injuries consisting of an enucleated (and ultimately removed) left eye and a coma, and he’s still receiving blood? Any combat related blood loss should have been restored days ago, and the fact that he still requires blood transfusions means something else must be going on the cause the blood loss.

2. There are air bubbles in the blood bag. This is a closed system — it’s not like the water cooler at the office — so there is no air to escape cause the bubbles.

3. The IV seems to be situated in his left biceps — painful, not very efficient — as opposed the the more common placement in the crook of the elbow.

A nice example of an incorrectly worn head mirror from Run #2, by Sturges and Williams.

Though as Dr. Milo admits, he’s more of a chemist than a physician, so maybe that’s why he doesn’t know how to position a head mirror (and actually seems to be wearing a small satellite dish).

In addition to watching the television show Fringe, I also read the Fringe comic published by WildStorm. The comic takes place years before the show, and features two stories per issue — one a continuing story featuring scientists Walter Bishop and William Bell, and a second stand alone story. This post is about the continuing “Bishop and Bell” storyline, the third chapter in particular.

When we meet William Bell in the first issue of Fringe, it is 1970 and he is a twenty year old college student at Harvard. He meets up with Dr. Walter Bishop and becomes his lab assistant.

The next issue takes place at some undetermined point later. Dr Bishop and William Bell are still working in a lab at Harvard. There is reference to experiments the duo performed “last year.” William Bell is also referred to as “Dr. Bell” which suggests he has had time to complete not only his undergraduate degree, but also his doctorate. Depending on how much credit you want to give him for being a genius, that would make it 4 to 8 years later, so the story takes place sometime between 1974 and 1978.

Why is this important? Because the timing seemed off to me — and it turns out I was right:

Neurontin is the brand name of Gabapentin, a drug originally developed to prevent seizures. Gabapentin wasn’t discovered until 1973 and was an experimental drug for years after that, so it’s unlikely that the doctors would be able to get there hands on any. Even if their mysterious “Soap Company” benefactors somehow managed to obtain a supply of the medication, it wasn’t known as Neurontin until 1983.

I’ll also point out that injecting serotonin into the body is not a good idea. It doesn’t cross over from the blood to the brain well (which one assumes is where they want it), and it acts as a potent vasoconstrictor (causes the blood vessels to clamp closed) in the bloodstream. High levels of serotonin in the blood have been linked with fatal lung and heart conditions.

Injecting LSD into the body — probably not the best idea either, but for different reasons (mainly due it being a potent hallucinogen). Speaking of LSD, it’s the chemical structure the worker holding the clipboard is looking at in the second story in issue #3.

Due to some unavoidable work and family obligations, my medical annotations of Vertical’s collections of Osamu Tezuka’s Black Jack were delayed, but now they should be back on track. Here are the annotations for the first seven stories from Black Jack, Volume 2. My medical annotations of Black Jack, Volume 1 (part one, part two) are still available.

For those of you unfamiliar with the character, Black Jack is a famous — or infamous — maverick surgeon. He is unlicensed, a fact which gets him into trouble frequently, but he is always able to avoid sanction due to his unsurpassed surgical skills.

The writer of Black Jack, Osamu Tezuka, attended medical school, but chose to become a mangaka rather than a practicing physician. Because of his training, his stories are quite accurate. Most of the medical discrepancies are due either to the advance of medicine in the three decades since the stories were written or to differences between Eastern and the Western medicine. Black Jack, like all of Tezuka’s manga, is phenomenal, so if you have any interest in manga or medicine, you should take the time to track down and read them if you haven’t already.

In my annotations below, I’ve added the year the story was first published. Consider this a strong Spoiler Warning as well. Click “Read More” to read the rest of the post.

In the early ’90s, Marvel Comics (and writer Mark Gruenwald in particular) decided that having one of their flagship characters, Captain America, gain his powers through drugs (in this case, the Super Soldier Serum) was a bad idea — after all, it was the tail end of the “Just Say No” era and drugs (all drugs) were bad. So Gruenwald concocted the Streets of Poison storyline which ended with Captain America undergoing an exchange transfusion, flushing the Super Soldier Serum from his body.

Only an unpowered Captain America wasn’t that interesting a character, so less than a year later Captain America was returned to his Super Soldier Empowered status quo. In the otherwise forgettable Captain America #384 (Captain America fights a giant ice worm in the Arctic), it is revealed that Cap’s Super Soldier Serum has regenerated and he has regained his super-powers. It takes a full page of talking heads to explain to Cap (and readers) what has happened, but this panel — which is nearly Claremontian in its amount of dialogue — sums it all up:

So somehow, over time, the Super Soldier Serum had become a “self-replicating virus.” This means two things: First, Captain America gets his powers back. Second, his powers are no longer due to drugs, but a “virus” and therefore he is no longer a “drug user” (remember, drugs are bad) and should not be censured as such. Just to hammer home the point, a few panels later, Cap says:

I guess there isn’t a lot of comparison between my situation vis-a-vis body altering substances and those who abuse conventional drugs.

(And yes, I realize the idea that a drug could become a virus is ludicrous, and the term “self replicating virus” is a contradiction, but it was how hard Gruenwald worked to dance around the “Captain America is on drugs” conceit that really caught my attention.)

Cut off a limb and two more shall take its place! But injure the heart…and they’re not quite sure what to do.

It looks like the poor Hydra agent is literally trying to massage the victim’s chest — and the victim sure seems to be enjoying it.
And the “two minutes to brain damage”? That’s about three minutes off. Five minutes of oxygen deprivation seems to be the minimum required to cause permanent brain damage.

Our Army at War #237 (Oct 1971)

An inspired cover, but I still must point out that blood plasma is yellow, not red.

(I know that I’ve complained — many, many times — about the incorrect use of plasma in contemporary emergency resuscitation scenes, but its use is proper in this scene as it was the main blood component used for emergencies in World War II.)

Wanting to see if I could scrounge up some more information on Kenneth Crichton’s “degenerative anemia,” I decided to go back to the sources.

Kenneth makes his first appearance in Captain America #253 and #254 (1981) in — appropriately enough — a Baron Blood storyline. The story also introduces the new (and current) Union Jack. He is drawn as a fairly robust young man, not much different than his friend Joey Chapman who goes on to become Union Jack. The art is by John Byrne who can actually draw skinny and less-muscled people well (Reed Richards and Nightcrawler come to mind), so I have to think the art choice is deliberate.

No mention is made of any anemia, disease, or weakness — Ken even tries to smack Baron Blood with a good-sized floor lamp — though at the end of the comic, he does make a comment that Joey was always the “stronger” of the two of them.

As far as I can tell, Kenneth next appears 17 years later in the first Union Jack mini-series (1998). Since we last saw him, his elderly mother has regained her youth thanks to a transfusion of the Human Torch’s blood. This fact does not sit well with Ken — he feels she is getting all the breaks while he has to suffer.

Ken’s anemia is large part of this storyline. He is drawn looking very thin, almost emaciated, and has a very pale color. The art is by John Cassady, who even at this early point in his career could draw well, so again I’m assuming the depiction is intentional.

In this mini-series, Ken is definitely weaker than average. He’s also a genuinely unpleasant person, a whiner, and a light-weight when it comes to alcohol — but most of this can be explained by his anemia, or his difficulty in coming to terms with his condition. His anemia is shown to be severe — he has to be evaluated at the hospital regularly — and at one point, his local doctor has to give him a transfusion at home to get him up and about.

No explanation of his “debilitating anemia” is given, and there is no suggestion at all that it ties in to his mother’s legacy. It seems New Invaders #5 (discussed yesterday) was the first mention of that idea.

All three storylines are available in collected edition. Captain America: War & Remembrance gets a strong recommendation (great Stern and Byrnes Captain America stories), Union Jack gets a moderate recommendation (fair story by Raab, good early art by Cassady), and The New Invaders is not really recommended unless you’re a sadist, an Invaders completist, or have money to burn.

Even before her revelation that she herself is a vampire, Spitfire’s history has been rife with vampiric shenanigans. Her origin revolves around a vampire bite and subsequent transfusion with android blood. Her son became a vampire and fathered a child on Baroness Blood before she killed him and the rest of her vampire followers by exposing them to sunlight¹.

That all brings us to New Invaders #5, where Spitfire has been captured by Baroness Blood. The Baroness explains that she needs Spitfire’s blood to keep her son — Spitfire’s grandson — alive. She goes on the explain that while the vampire bite/android blood gave Spitfire her powers, it caused an inherited degenerative blood disorder in her son², a disorder that was then passed on to his son³. The only way to keep the Baroness’s child alive is to regularly feed it Spitfire’s blood. Thus the Baroness has captured Spitfire and has her tied to a gurney (and continually transfused with blood⁴) so she can provide sustenance for junior whenever he wants it⁵.

The Baroness’s other plan is to feed her vampire lackeys⁶ some of her blood so that they will gain immunity to sunlight. Though unlike her, their immunity will only last for a few days. Still, that’s enough for them to wreak havoc across England. The Baroness also feeds her vampires some of Spitfire’s blood, though the reason for this is never explained – well, other than allowing the good guys a deus ex machina ending⁷.

Notes:
1. Not only did the Baroness clearly skip the leadership lectures of vampire school, but she never read the Evil Overlord list. (This all takes place in the first Union Jack mini-series.)

2. Apparently the vampire bite and/or android blood caused a deleterious mutation in Spitfire’s germ line cells, which is interesting because by that time in her life, her eggs had already formed. So either the blood disease was not related to the vampire/android blood, or they somehow mutated already formed cells.

3. It looks to be an autosomal dominant mutation, which means that a single copy of the mutated gene is enough to cause the disease (so it’s not a disease where the normal gene is simply not working — because that generally means both copies of the gene must be abnormal to see a negative effect — but instead one where the mutated version of the protein is actively causing the disease). This still doesn’t explain how Spitfire’s blood would keep the disease in remission. Maybe her mutated blood cells counteract the abnormal ones in the baby?

4. I’ve mentioned this before, but it bears repeating: why is an English vampire based in England using blood from the American Red Cross?

5. For a three to sixth month old baby, Johnny sure has a mouthful of teeth. I’m guessing vampire babies teeth a lot earlier than human babies.

6.The Baroness’s new lackeys that is, since she killed all of her previous ones. This is why you should always do some research on a prospective employer before signing on the dotted line.

7. The Human Torch (the android one) realizes that since the vampires drank Spitfire’s blood, they also have his blood in their system, thus he uses his powers to ignite his blood in the vampires, causing them all to burst into flame. Sound familiar? He just did the same thing to Ultron’s LMDs in the Avengers/Invaders series.

Lex Luthor’s brilliant plant is to use his special maser ray to erase Batman’s mind and then transfer Superman’s mind into Batman’s mindless body. Now that Superman’s mind is no longer housed in an invulnerable Kryptonian body, Lex will physically pummel him until he dies.

I hope it comes as no surprise when I reveal [Spoiler Warning!] that through a cunning plan of their own, Superman and Batman are able to avoid the fiendish trap and defeat Luthor. In hindsight, they really didn’t have to put as much effort into it as they did — Luthor’s plan was flawed at a very basic level.

Luthor seems to believe that light (and similar forms of electromagnetic radiation) are transmitted through the pupil, across the eye, and then down the optic nerve into the brain itself. This is a very common misconception. In reality, the light never reaches the brain because it never passes beyond the eye.

Quick Summary of how the Eye Works:

Light enters the eye through the pupil and falls upon the retina, a special layer of cells at the very back of the eye. The cells of the retina “translate” the light into nerve impulses, and these impulses are what travel down the optic nerve to the visual centers of the brain.

Take home message: Light stays in the eyes; nerves go to the brain

Sorry Lex, your plan is defeated by basic anatomy and physiology. Better luck next time.

storyline reprinted in the book The Strange Deaths of Batman. You really need to pick up this book, if nothing else for the color reprint of The Brave and the Bold #115, the infamous story where the Atom literally jumps into the head of a brain-dead Batman and steers him around, solving crimes and taking out bad guys.

scene from Young X-Men #11 (Guggenheim, Sandoval)

Does Henry have anything to worry about? Can he be kicked out of the American Medical Association for breaking doctor/patient confidentiality?

Yes, and no.

1. You can be expelled from the AMA for breaking its ethical rules, and these rules include patient confidentiality.
2. On the other hand, Henry can’t be kicked out of the AMA because he can’t be a member: he’s not a physician. Sure, he practices medicine for the X-Men, and he has at least one Ph.D., but he has never earned a medical degree, and thus he cannot be a part of the AMA.

While I’m talking about the AMA, there seems to be a misunderstanding among writers (both comic book and television) about what exactly the American Medical Association does.

It is a physician and public health advocacy organization whose mission is to “promote the art and science of medicine and the betterment of public health.” It has a charitable wing and it has a powerful political wing. The AMA publishes a number of medical journals, the best known is the eponymous JAMA (the Journal of the American Medical Association).

scene from Dr. Mid-Nite #1 (Wagner, Snyder)

The AMA does not issue medical licenses or revoke them; that is the duty of the medical boards of each individual state. From the AMA website: “the AMA is not in a position to take action against a physician’s license to practice medicine.”

Despite what most people seem to believe, membership in the American Medical Association is not mandatory — in fact, less than a third of physicians are members of the AMA (15-30% depending on whose data you accept).

A good season finale for Fringe. Lots of mysteries were tied up, or at least explained, but enough were left for next season to explore.

The Plot: Nina Sharp has been shot by David Robert Jones and is rushed into surgery. Agent Dunham and her team review the surveillance tapes and notices that Jones did something to Sharp’s bionic arm. After she recovers from surgery, she tells them that he stole an extremely powerful power cell that had been hidden there. Sharp tells Dunham that Jones was once an employee and protégé of William Bell, and he was fired for reasons she refuses to articulate. She goes on to tell Dunham that Jones is hunting for Bell so he can kill him. If Dunham can stop Jones, though, Nina will guarantee her a meeting with the elusive Bell. Nina goes on to explain that Bell is currently living in an alternate dimension, and Jones is trying to travel to that dimension to pursue him. Pulling all the “x-files” the FBI has, Dunham is able to come up with a pattern to the “Pattern” which points to Reiden Lake as the epicenter.

Meanwhile, Jones has set up a strange machine in a New York City street. It emits a high pitched whine, and then open a shimmering doorway into another dimension. A truck comes barreling through, but is cut in half when the unstable doorway closes. Jones later tries the same trick on a soccer field, but this time an unfortunate player is cut in half. He heads to Reiden Lake to try a third time.

Over in Massachusetts, Walter has gone missing. Peter tracks him to an old beach home the family owns. Digging through various boxes, Walter finds what the Observer sent him to locate: a machine that plugs dimensional holes. He and Peter head for Reiden Lake, because Walter tells Peter that’s where he opened the first doorway.

Dunham’s team meets up with the Bishops, and together they confront Jones. He has opened his doorway and is about to go through when Dunham shoots him, again and again. He shrugs off the bullets, explaining that while the radiation from the teleporter may be slowly killing him, in the meantime, it has made him more than human. He finally enters the doorway, but Peter uses Walter’s machine to shut the gate, cutting Jones in half and killing him.

As the episode ends, Walter stands tearfully over a grave labeled “Peter Bishop, 1978-1985″ — so the Peter we know must be the Peter from the alternate dimension. Olivia finds herself transported to the alternate world where she meets with William Bell in his office in one of the towers of the World Trade Center.

1. I’m As Shocked As You
The medicine in the emergency room scene was pretty spot on, so no complaints from me there.

2. It Keeps Going and Going and Going
I like the way Jones was being particularly careful with the energy cell, like it was on the verge of exploding. Meanwhile, Nina had just schlepped it around in her arm, swinging it this way and that, not careful at all.

3. Flight 19, Where Are You?
“The Pattern” works best when it is all fictional. Trying to work in the Bermuda Triangle just cheapens it for me — especially as all good skeptics know, there is no real mystery there at all.

4. A Little Dry
I’d expect more blood out of people cut in half.

5. You Must Learn To Govern Your Passions; They Will Be Your Undoing
There is little Leonard Nimoy can’t add a touch of class gravitas too — well, except this (and this).
Actually, I was expecting more from him. It sounded like he was on the verge of cracking himself up.

A good episode. I liked that it actually answered some questions, which was frankly more than I expected. Of course, there’s still a bunch left for next year. Anyway, it was a good episode — good enough to move the clock back to 11:55

A perfectly serviceable episode of House – for the middle of the season, anyway. As a season finale, it was a bit of a let down (until the last five minutes, that is).

Scott is a 20 year-old who has undergone surgery that cut his corpus callosum (the part of the brain that allows the left and right sides of the brain to communicate) to treat a seizure disorder. The seizures have resolved since the surgery, but he has subsequently developed Alien Hand Syndrome, where he has no control at all over his left hand and it seems to have a mind of its own. He is at a restaurant on a date, complaining of bland food, when his left hand starts throwing rolls at an obnoxious diner at another table. A fight ensues, and before the melee even starts, we notice blood dripping from his eye.

Scott is admitted to House’s service for evaluation of his bloody tears and loss of his sense of taste. The initial differential diagnosis includes autoimmune disease, nasolacrimal tumor, infection, or the common cold. House has Taub and Thirteen search Scott’s apartment and they find mold growing on the ceiling in his bathroom. They decide this is the cause of his symptoms and start him on anti-fungal medication. About this time, Scott has a fight with his girlfriend, his left hand slapping her, and she storms out. He tries to follow her out but finds that he cannot walk. The differential now consists of dehydration or a meningioma (the most common tumor of the central nervous system) — only it’s a special meningioma that is allowing the two sides of the brain to communicate again. Instead of running an MRI or CT scan to look for the tumor, they run a test to see if there is communication between the left and right brain. The test is negative, but House notices that Scott is shivering. He also detects an ammonia scent to his breath and sees a caput medusae on physical exam, all signs of liver failure. House suspects the liver failure is due to sarcoidosis and has the team perform a liver biopsy. While performing the biopsy, Thirteen sees splinter hemorrhages (a sign of trauma or tiny blood clots) under Scott’s fingernails. He then takes a sudden turn for the worse, vomiting blood while his oxygen saturation and blood pressure drop.

The team now decides that Scott has a clotting issue, and start him on heparin (a blood thinner). An echocardiogram is normal, so the heart isn’t the source of the clots. They’ve also run tests for Factor V Leiden, Protein C, and Protein S (all things that can cause a clotting disorder), but they’re also negative. Thirteen now recalls his mention of always being sweaty and wonders if that might be a symptom of whatever disease he has. Cancer is thought to be the most likely, particularly lymphoma or pancreatic cancer. House strongly suspects the latter, even when an MRI of the pancreas is normal. He has Chase perform a new test where scorpion toxin and infrared dye is painted on the pancreas and will light up any cancer cells. There isn’t any sign of cancer, but once again Scott starts to develop a dangerously low blood pressure. House now realizes that the clotting problem is caused by his heart throwing off clots, but only when he slips into an arrhythmia, which he does under stress (like surgery or a biopsy), or every now and then. Sure enough, Chase checks a transesophageal echocardiogram and finds an abnormal rhythm and clots in the left atrial appendage. The heart throwing clots explains most of Scott’s symptoms, but what explains the heart condition? The new differential includes rhabdomyolysis (muscle disease), Graves disease (an autoimmune disease that causes too much thyroid hormone to be produced), and Cushing’s Syndrome (a condition where the body makes too much cortisol, a steroid). The Cushing’s seems the most likely, and a dexamethasone suppression test is ordered. About this time, Scott’s girlfriend returns and points out that his left hand only seemed to get “agitated” when Scott’s deodorant was involved. It turns out to be a special deodorant that Scott has to special order. Taub checks on it, and sure enough, one of the ingredients has been shown in one case to cause a heart condition and therefore this is decided to be the cause of Scott’s problem. End of case. Taub also notes ironically that the chemical has been implicated in seizure disorders, and maybe Scott had not needed the surgery in the first place.

As usual, major complaints are in red, minor in blue, nit-picking in green:

Patient has neurological signs (loss of his sense of taste, inability to walk) and they even suspect a brain tumor, yet they never check a CT or MRI of the brain?

The liver failure, particularly the varices and caput medusae, developed way too quickly — or else they’ve been there for a while and the team did a piss-poor physical exam.

It caught my attention when the script was vague about propylene glycol causing “heart problems.” From what I can find, it can cause arrhythmia, particularly bradyarrhthmias (abnormally slow heart rates) and QRS abnormalities. I don’t see any connection between it and atrial fibrillation, the arrhythmia that would cause Scott’s symptoms (again, left unnamed in the script).

The patient is crashing in the OR and no one thinks to look at the cardiac monitors?

I was surprised how quickly the team accepted that propylene glycol caused his problems and just stopped there, other more likely causes left untested for.

While giving blood thinners to someone with a clotting disorder is a good idea, they might want to think twice about giving it to someone with bleeding esophageal varices (at least I assume he has them, that’s the only thing that fits and can explain the vomiting blood).

Chlorotoxin-based (scorpion venom) tumor paint has been used in animal models, but I’m not sure it’s been tested in humans yet. It seems like an extreme step to take though. One of the first things I was taught (and taught loudly) on my surgical rotation was “don’t mess with pancreas” — though the language was more colorful.

So a clot to the brain caused the lack of taste , but what caused the bloody tears?
And don’t tell me “subconjunctival hemorrhage,” that was an embarrassingly bad suggestion of Taub’s.

I like that the writers finally acknowledge that storylines are often built on single case reports (not that there’s necessarily anything wrong with that).

The medical mystery was mediocre, and they never explained one of the opening symptoms. His underlying condition (Alien Hand Syndrome) was more interesting that the mystery: C. The final diagnosis fit the symptoms, or at least the main ones, it just seemed the team accepted that the deodorant caused it too easily. I give it a B. The medicine overall was superficial and rushed, but not horrible. I give it a weak B. The soap opera was the highlight of the show, particularly the end scenes with Cuddy and Wilson and earns the show an A in this regard (though shouldn’t Cuddy have been mad that House lied to the clinic about sleeping with her, and not just yelled at him for discussing her sex-life?).

Last week’s House review
A list of all prior House reviews

A straight forward public service ad this week, reminding us all to eat a good breakfast every day. I really can’t argue with this: breakfast is an extremely important meal.

I do wonder if Danny skipped lunch too, or I’d think he’d have energy for basketball practice since it generally takes place after school.

I’d also not impressed by Miss Jones’ teaching skills — maybe she skipped breakfast too.

This PSA was written by Jack Schiff, with art by Win Mortimer. This PSA was found in various March 1954 editions of DC comics, including Adventure Comics #198, where this ad was obtained.

More PSAs

Tags: comics psa buzzy breakfast basketball jack schiff win mortimer

For episode 23, Catesby had the high score with 12 points.

Overall, with just a single episode remaining, The Erskine retains a strong lead with 82 points. Ron remains in second with 72 points. Ash is in third with 71 points. Dogma-Central, Nekolux, and TRad are tied for fourth with 66 points.

Full scores are available here.

Action Comics #871 “New Krypton, part 2: Beyond Doomsday”
Geoff Johns, writer
Pete Woods, penciler

Geoff Johns is usually one of the better writers at incorporating science — or at least decent pseudo-science — into his stories. But in this scene from a recent Action Comics I have to call his bluff:

Superman: You know of Doomsday, Zor?

Zor-El: We know of him.

He was scientifically created on ancient Krypton through the the violent and vile process of Forced-Evolution.

A child was sent into the wild, killed and then cloned from the remains and the process was repeated…

…until that child had evolved to withstand the harsh environment and bloodthirsty creatures of our primordial world.

Here are three good reasons that this “forced-evolution” is utter nonsense and could not have worked:

1. Evolution requires change, particularly change at the genetic level. In the process Zor is describing, there is no change. Cloned individuals have identical genetic codes. Since each generation is a clone of the previous generation, their genetics are identical and the scientists are essentially sending the same kid out again and again and again. This is not evolution; it’s stagnation.

2. Zor seems to imply that the child abandoned in wilderness develops some new skills or abilities to help him survive and this is what leads to evolution. The child may certainly have acquired what he needed to survive the wilds (but not, apparently, survive the scientists), but it’s all a moot point: acquired abilities cannot be inherited.

3. Finally, species evolve, not individuals.

If the Kryptonian’s grasp of geology is as good as their understanding of biology, it’s no wonder nobody but Jor-El noticed the planet was going to explode.

A rather unexciting episode of Fringe overall, despite several clever plot concepts. Definitely a “sum of the whole is less than the parts” week.

The Plot: A young woman is desperately trying to get to a hospital when she suddenly catches fire and explodes. Agent Dunham and her team are called in to investigate. Through dental records, they are able to identify her as Susan Pratt, a 29 year-old toll booth attendant. They search her apartment and find a large check made out by a mysterious lawyer, a lawyer whose office seems hurriedly deserted. Walter initially suspects spontaneous human combustion, and then deduces that Susan was a pyrokinetic (think Firestarter) who could not control her own powers.

Meanwhile, Agent Dunham is having recurrent hallucinations. Walter tells her that she is experiencing déjà vu, which he explains are visions of an alternate reality. The next time Dunham has one of the hallucinations, she investigates and discovers that in this reality, Susan had a twin sister Nancy. Sure enough, in our reality there is a twin sister too, and Olivia’s team rushes to Nancy’s apartment, but she has been kidnapped. Luckily, Peter has invented a machine that can pull sounds from an apartment window which was melted during the kidnapping. Uncovering the sound of a phone dialing, Olivia is able to trace a call made to Sanford Harris’ phone (if you can’t remember, Sanford Harris is the new a**hole boss at the FBI who took over earlier in the season). She and Charlie track Harris to a warehouse where he and the lawyer have locked up Nancy and are experimenting on her. In the final confrontation, Nancy is rescued and Harris burned alive by her pyrokinesis.

The episode ends with a variety of short scenes: Olivia confronts Walter about the experiments he and Walter Bell performed on her and other children, Nina visits Broyle to discuss the reappearance of the Observer, Walter discovers the missing original ZFT manifesto just as the Observer walks in and tells him it is time to go, and Nina is shot by masked men in her apartment building.

1. Walter’s Reality, Quite Different From My Reality
A myth is an unverified fact? I’m sure Zeus would be happy to know he’s factual, merely unverified.

2. Again and Again
That is an interesting explanation for déjà vu. Just saying.
Would Robert Frost approve?

3. Too Close a Look
There are so many things wrong with Peter’s electron microscope/Geiger counter/mp3 player. Here are just a few:
Electron microscope samples have to be specially prepared.
At electron microscope level, there would be so many natural grooves and bumps in the surface of the glass that it would have tremendous background noise. Even an LP or CD at that level of detail would have so many imperfections it would be hard to hear the actual sound.
A flash fried window captured that much sound?
Peter was somehow able to reproduce the sound perfectly down to the exact voices and tones of a dialing phone?

4. Irony
I had to laugh when Walter told Olivia she was a good investigator — she’s anything but. For instance, she missed the entire closet full of gray clothes and the check from a mysterious lawyer that all tie into the emotion spewing guy from episode 17.

5. Y Kant Olivia Read?
Olivia is a cornflake gal. Is that anything like a Cornflake Girl?

A plainly mediocre episode. Not bad enough to advance the clock, but not good enough to gain some time. (With just one episode left, it is extremely unlikely the Doomsday Clock will run out…this year at least. Fringe has been renewed, so I’ll continue the clock next year.)

I wanted to like this episode of House, I really did, but the absolutely horrible medical care just wouldn’t let me.

There is an accident during a ballet recital, and 21 year-old ballerina Penelope drops to floor, gasping for breath. She is admitted to House’s service and found to have lungs that “keep collapsing” despite the use of chest tubes. Supplemental oxygen can only raise her oxygen saturation to 60%. The team reports that there are no tumors is her lungs and no evidence of any lung punctures. There is also no bruising, trauma, or evidence of sexually transmitted diseases. Her white blood count and temperature are normal, ruling out pneumonia. House suggests a pulmonary contusion, but it is pointed out that her CT scan was normal. He then decides that she is dehydrated and this is masking her pneumonia, so he orders her started on intravenous fluids and antibiotics.

When Penelope fails to improve on the antibiotics, House wants to do a more invasive test to look for the pneumonia. He is told her lungs can’t tolerate a bronchoscopy, so House decides on a transtacheal aspiration. As always seems to be the case, there is a complication during the procedure. This time, her skin starts sloughing off — not just a little bit, but almost all of it. An autoimmune disease is suggested as a cause for the skin problem. House tells them that he is suspicious a liver tumor has caused the lung problem (by eroding into the lungs). Furthermore, he tells the team that her skin problems is toxic epidermal necrolysis — caused by the antibiotic they gave her.

An ultrasound shows a liver mass. The team can’t perform a standard liver biopsy because without her skin, she is at an increased risk of bleeding out. Instead, they go with a transjugular approach. They obtain the liver biopsy and it is negative for cancer, but she is knocked into the abnormal heart rhythm atrial fibrillation. Wilson suggests giving her metoprolol to lower the heart rate, but Foreman rather brusquely shoves the idea aside. The team has apparently decided that the atrial fibrillation must be caused by something within the heart itself, and want to get an MRI of the heart to get a closer look. Unfortunately, the very atrial fibrillation they are concerned about means that they would be unable to get good results from the scan (the heart would be beating too rapidly and irregularly to get a clear image). They decide to stop her heart, take the MRI, and then restart the heart. To prevent brain damage, there is a strict 3-minute deadline. Foreman thinks he sees something in the aorta, but by then the three minutes are up and the MRI is halted.

House agrees that Foreman saw something in the aorta. The differential now includes tumor, scar tissue, or abscess. Looking at Penelope’s boyfriend, House thinks he is spending so much time with her because he feels guilty, so House deduces that the boyfriend must have given her gonorrhea, which led to an abscess in her heart. The boyfriend is tested and sure enough, he has gonorrhea — only he got it from her and not the other way around. Meanwhile Penelope goes into septic shock and they can’t operate to remove the abscess until she’s stabilized. The team decides to give her dopamine (a medication used to raise the blood pressure in critically ill patients) in order to stabilize her. It works, and Chase is able to remove the heart abscess, but unfortunately the dopamine has cut off the blood flow to her hands and feet and they are turning black and starting to die (dopamine can cause occlusive vascular disease). Chase recommends that she has them amputated, but she refuses. After a fair amount of bickering among the team, Taub decides to go with the Hail Mary pass of injecting her with vasodilators to open the closed off blood vessels. Miraculously, it works and her hands and feet are saved.

House’s hallucination of Amber persists. He tells Wilson what is going on, in a round about way, and insists it must be sleep apnea — but he knows it isn’t, because the symptoms don’t fit at all. A sleep study is normal; no apnea. He has a blood test to look for infection, but it is negative as well. He decides the guilt he is feeling about causing the patient to develop TEN is a symptom of multiple sclerosis, but the tests for MS are all negative. He is down to two causes for the hallucinations: schizophrenia or his Vicodin use. He knows schizophrenia doesn’t really match, but he wants it to be that instead of the Vicodin. But eventually House realizes it must be the Vicodin causing his problems and asks Cuddy to help him go through the unpleasantness that is narcotic withdrawal, because she knows him best and won’t let him get away with anything.

As usual, major complaints are in red, minor in blue, nit-picking in green:

It’s not clear to me exactly what caused Penelope’s lung collapse that started the whole business. Was it the heart abscess? The show more or less implied it was, since the team felt that solved her problem, but I don’t know how a heart abscess would cause her lung(s) to repeatedly collapse.

They might have been able to raise her oxygen saturation above 60% if they took her off the nasal canula and used a proper oxygen mask instead.

In this episode, the writers are having a bad case “having your cake and eating it too” in terms of Penelope’s heart abscess. The abscess that is walled off, sealing the bacterial infection away from the rest of her body, making it much harder to detect and treat. However, despite being walled off, the abscess is able to:
Cause septic shock
Deflate the lungs

When we talk about dehydration hiding a pneumonia, we’re talking about the x-ray. An infiltrate (the sign that appears on x-ray showing a pneumonia) does not show up well in a dehydrated patient. Give them some IV fluids, repeat the x-ray, and boom — there’s the infiltrate. Dehydration does not mask the other symptoms he mentioned (temperature, white count — if anything, dehydration will falsely elevate the white count).

You cannot draw a “Vicodin level”. You can draw an acetaminophen (Tylenol, paracetamol) level, but not an hydrocodone level (the two drugs which make up Vicodin). Wilson could have been talking about high acetaminophen levels (which causes irreversible liver damage), but his tone and presentation suggested he was talking about the narcotic component.

The time course of toxic epidermal necrolysis makes it more likely the condition was caused by Penelope’s use of medication (say non-steroidal anti-inflammatory drugs for sore muscles from ballet) than by any antibiotics she received in the hospital.

Lack of overlying skin should not prevent a standard liver biopsy since it doesn’t decrease her blood’s ability to clot. (You could argue that it should be avoided because it would raise the risk of infection, and I’d buy that, but that’s not what they mentioned).

While I agree the heart monitor was showing a narrow complex tachycardia, it didn’t look like atrial fibrillation to me (way too regular a rhythm, for one).

Speaking of atrial fibrillation, I would have liked them to look a little harder at other causes (say thyroid) before immediately deciding it was something within her heart.

While metoprolol controls the rapid rate of the atrial fibrillation, it doesn’t covert it to a normal rhythm. There are other medications that can do that.
I’m not an electrophysiologist, but whenever I’ve seen someone’s heart stopped electrically, they’ve used internal leads, not external paddles.

A “negative ANA” does not magically rule out all autoimmune diseases. Plenty of people have an autoimmune disease without a positive ANA.

A transtracheal aspiration involves a needle, a tiny catheter, and saline. There is no knife — nothing needs to be cut!

Did they ever convert her out of a-fib, or is she still in it (or did removing the abscess clear that up)?

I assume they put her on a heart-lung machine during surgery, but it would have been nice to mention, since they made such a big deal out of stopping the heart earlier.

Eye protection in surgery, team.

The medical mystery was okay, or it would have been had they stayed with it (I’m still wondering what caused her lungs to collapse), so I’ll give it a B-. As I’ve mentioned above, the final diagnosis doesn’t really fit the presentation, or her complex of symptoms. It earns a D. The medicine overall? Well, take a look at the sheer length of this week’s list of concerns and tell me how it can earn anything other than an F. The soap opera was good, but I feel it could have been better. Still, I’ll give it a B+.

Last week’s House review
A list of all prior House reviews

UPDATED:
This week, Nekolux has the high score with 22 points.

Overall, with just two episodes remaining, The Erskine continues in the lead with 79 points. Ron is in second with 69 points. Ash and Dogma-Central are tied for third with 65 points, which leaves George to round out the top five with 64 points.

Full scores are available here.

Mighty Avengers #24 “Chasing Ghosts”
Dan Slott, writer
Rafa Sandoval, penciler

In last week’s Mighty Avengers #24, Norman Osborn unearths one of the bones of the dead hero Goliath and brings it back to his headquarters for evaluation:

The clavicle, or collarbone, is an s-shaped flat bone that is found in the front part of the shoulder.

Whatever bone Osborn found looks like a long bone, such as the femur (thigh bone) or humerus (upper arm bone). Unlike the clavicle, it is round, instead of flat; straight, instead of s-shaped; and has knobby ends. If anything, it most resembles those perfectly symmetrical bones that cartoon dogs always carry around. Whatever bone he stole, it is definitely not a clavicle.

Norman Osborn:
Psychopathic megalomaniac
Qualified anatomist

They almost made it for a complete episode without screwing up the science…almost.

The Plot: Strange murders have been occurring in Boston, murders where the victim has their spinal column ripped open and have been drained of spinal fluid. Agent Dunham and her team are called in after the second murder. While examining the body, Walter finds traces of Treponema pallidum, the bacteria that causes syphilis — only it’s a variety of syphilis that has been extinct for decades. They trace the syphilis to the CDC who note that they recently sent a sample of that very syphilis to Lubov Pharmaceuticals. The CDC also mentions that the same research lab ordered RND-390, a component of the rapid skin growth bioweapon seen previously.

Olivia and her team raid the lab — only it’s not a real lab, just a split-level house in a residential area. They arrest a wheelchair-bound scientist named Boone and bring him in for questioning. He admits to working for the ZTF and having developed the rapid skin growth weapon, as well as playing a role in whatever is terrorizing the city now. He tells Dunham that he will help her, only they need to rescue his wife who was kidnapped by the ZTF to ensure he keeps working for them. Eventually, Boone admits that his wife is not a hostage, but has been dosed with a contagion that has turned her into the killer stalking the city. If Dunham and her team can capture his wife, he will concoct an antidote and then tell Dunham everything he knows about the ZTF.

Dunham, Peter, and Charlie capture the wife and brings her back to the lab where Walter and Boone have concocted an antidote. The cure is a success, unfortunately Boone died of a stroke while making it. He leaves a videotape for Dunham naming names. He doesn’t know much, but reveals to her that the money man behind ZTF is William Bell.

1. Free Samples
The CDC is a little free with their germ samples, aren’t they? Particularly the bioweapon ones.
And they know the lab is in a residential area, but don’t seem to think twice about it.

2. It Goes to Eleven
How does giving cerebral spinal fluid to his wife going to cause Boone to become paralyzed? If that’s the case, then everyone who ever had a spinal tap would be in a wheelchair.

3. FBwhat?
Astrid gets the “Only Agent Actually Investigating” Award for her finding-the-club-stamp moment.

4. Billy Squire
Taking too much spinal fluid is not going to cause a stroke; if anything, it’s going to cause a herniation (the brainstem is pushed downward over sharp bony prominences and damaged — and not in a good way). At the least, it’ll give him a nasty spinal headache.
Because it’s not a stroke, the medication tPA (tissue plasminogen activator, a “clot busting” drug) is not going to do any good. And even if it were a stroke, tPA is not necessarily a good idea. If it is a stroke caused by a clot, then tPA is indicated, but if it is a stroke caused by bleeding in the brain, then tPA will make it worse. There are very specific rules about giving tPA to minimize the risk of bad outcomes.
Regardless, you don’t stab someone in the neck with a syringe of the medication.

5. K.I.S.S.
Why inject the antidote into the spinal column at the cervical spine (neck level)? It’s a tough shot, and runs a risk of injuring the cord. Since the CSF circulates throughout the spinal column as a whole, injecting the medication at the lumbar level will have the same effect, only be easier and less risky.

Everything was going for this episode, and I was going to move the clock back again, but then they started talking about stroke and tPA and lost all benefits. The clock stays in place this week.

An episode of House with some decent medicine this week. There was also a bachelor party and House may be slowly going insane…

Seth Miller is a fourteen year old who has been deaf since he had meningitis at the age of four. He is a high school wrestler and is competing in a wrestling match when he suddenly screams and clutches his ears, where he is now hearing painfully loud explosions.

Seth is admitted to House’s team. Foreman immediately rules out “the usual suspects:” insomnia, migraines, and head trauma. House suggests it is temporal lobe epilepsy and sends Seth to the seizure lab where they try to induce a photosensitive seizure with flickering lights. He suffers no seizures, but loses the vision in one of his eyes. The team now suspects it is subclavian steal syndrome (blood that should go to the brain goes to the arm instead) and wants to perform an angiogram. House agrees, then has a conversation with himself and decides that Seth has optic neuritis. He interrupts before the angiogram can be performed and shows that Seth has neuropathy (he cannot feel the vibrations from the boombox in his hands, but can elsewhere in his body). The differential now includes increased intracranial pressure (ICP) from a brain tumor, or rhabdomyolysis (a muscle disease, in this case felt to be caused by losing too much weight for wrestling). House disagrees at first, but then changes his mind, deciding that Seth must have neurofibromatosis (neurofibromatosis, type 2 — i.e. NF2 — to be precise) tumor in his brain. An MRI is obtained and shows no tumor, but it does show a bulge in the wall of the fourth ventricle that was not present on an MRI from several years earlier. House thinks the bulge represents a tumor and has Chase perform a biopsy. House also has Chase install a cochlear implant while the patient is undergoing surgery.

Seth now develops a fever. The team suggests a post-operative reaction, an Arnold-Chiari malformation, pseudotumor cerebri, or Epstein barr virus. Foreman, who’s in charge now, favors that latter and starts Seth on ribavarin. Seth now develops urinary incontinence, which makes the team rethink their diagnoses. They suggest sarcoidosis, glomerulonephritis, and pheocromocytoma. House, after another conversation with himself, believes the problem to be heart related and wants a four-hour EKG on the patient. Foreman ultimately relents, but the heart study is normal. The team now suggests it may be Hashimoto’s Thyroiditis. House wants to continue studying the heart, but Foreman chooses to go with ordering a thyroid panel. House decides to induce an arrhythmia in the patient with some asthma medications, but when he arrives at the room to perform the dastardly deed, he discovers that Seth has pulled out his cochlear implant and in the process knocked himself into an arrhythmia, saving House the effort. Thrombocythemia is suggested as a possible diagnosis as is a pulmonary embolus. House tells Foreman that Seth is experiencing the Uthoff phenomenon, a sign of multiple sclerosis, and has him start him on interferon.

Everything goes well at first, and Seth is improving, but then he goes into “lung failure” and needs to be intubated and placed on a ventilator. This means multiple sclerosis is the wrong diagnosis. Eosinophilic pneumonitis is suggested. Hoarseness is a hallmark of this condition, so Foreman goes to check if Seth is hoarse. He is not, but while there, Foreman notices tobacco stained teeth and Seth admits to chewing tobacco in the past. This is enough to let Foreman know that Seth has sarcoidosis. When he was chewing, the immune suppression from the tobacco kept it in check, but now that he has stopped chewing, the sarcoidosis has flared up.

As usual, major complaints are in red, minor in blue, nit-picking in green. I didn’t really have any big complaints tonight, just blues and greens:

The medicine was fairly good, but also fairly superficial tonight. There was a great deal of jumping from half-hearted diagnosis to half-hearted diagnosis and abandoning previous diagnoses at the drop of a hat (you can have glomerulonephritis without brown urine, and eosinophilic pneumonitis without hoarseness). The whole heart arrhythmia thing was essentially a red herring and it didn’t affect the speed of the final diagnosis at all (now if they had gotten an echocardiogram, or at least a good look at the heart — which they usually do after an unexplained arrhythmia — they would have noticed granulomas and made the correct diagnosis earlier. Funny how they skipped that step this week.)

House’s prescription bottle read “Zolpidem” (i.e. Ambien, a reasonable choice for a sleeping medication), but then it said 200MG (the dose of zolpidem is 5-10MG. It doesn’t come in 200MG, after all, that’s twenty times the highest recommended dosage). The bottle also read “take three times a day.” Zolpidem is only to be taken at night. What’s the point of taking a sleep aid 3 times a day?

Seth must have been chewing an awful lot of tobacco to suppress his immune system enough to suppress the sarcoidosis.

How accurate are MRIs and CTs at determining ICP, particular the subtle increases seen in tonight’s episode? I thought the opening pressure of the lumbar puncture was the best way to determine ICP — though IANAN (I am not a neurologist).

Lung failure — not a common medical term at all. Respiratory failure would have been a better choice.
Why didn’t the sarcoid granulomas show up on the chest x-ray?

Not all seizures can be induced with flickering lights, only people with photosensitive seizures.

How can you tell is someone who is just extubated is hoarse? Intubating, extubating, and being on the ventilator can all cause hoarseness.

MRIs aren’t used to diagnose a broken nose.

The medical mystery itself was good this week and deserves a B. The final solution fit, but the tobacco-suppression was was quite a lucky coincidence; I give it another B. The medicine was pretty good, though the reasons to choose and discard diagnoses seemed more superficial (and incorrect) than usual. It earns a B-. The soap opera was excellent. I enjoyed the look at how House’s subconscious worked, and using Amber’s ghost to play that part was perfect. The bachelor party was well done too, I particularly liked how he held in it Wilson’s apartment. A.

Last week’s House review
A list of all prior House reviews

A low scoring episode this time, with Cheryl and FlowerPower tying for the high score with 6 points for the week.

Overall, The Erskine maitains the lead with 63 points, while DrBoy remains in second with with 57 points. Ash stays in third with 55 points, and Dogma-Central drops to fourth with 53 points. Ron moves into fifth with 52 points.

Full scores are available here.

Dennis the Menace Takes a Poke at Poison was published in 1961 by the United States Department of Health, Education, and Welfare (which split in 1979 to form the Department of Education and the Department of Health and Human Services). In a mere sixteen pages, Dennis and the rest of the Mitchell family cover a variety of poison-related topics, including — but not limited to — children’s medicine, pet medicine, spoiled lunchmeat, toxic wild berries, bug bombs, and weed killers.

Dennis learns not to give human medications to dogs, not to take medication without his parent’s approval, not to eat wild fruits and berries, and to be careful when using insecticides and herbicides.
Mr. Wilson learns that Dennis is a threat to society and danger to his very life (though I suspect he already knew that).
Sadly, Mr. and Mrs. Mitchell don’t seem to learn much and continue with their pattern of irresponsible parenting.
Ruff learns nothing, because, frankly, he’s a dog.

Dennis the Menace Takes a Poke at Poison’s greatest hits:

A revised version of the comic was published in 1981, but I only have a copy of the original.

More PSAs

Tags: comics psa dennis the menace poison mr wilson ruff

Caleb Ketchum is a three-time loser. He started out as a college chemistry professor, but quit because he wasn’t making enough money. Instead, he sets up shop as an exterminator, using his chemistry knowledge to invent a special termite-killing spray. When this didn’t bring in the money either, he advertises his skills to the local mob bosses through an ad in the paper. They take him up on his offer and use his super-termite spray as a to kill guards and unfortunate passers-by during robberies.

Things go well at first, and Ketchum is making more money than he ever dreamed. Who knew crooks made more than college professors or exterminators? He’s running low on Cacobane though, the rare chemical that forms the basis for his super-termite/death spray.

Unfortunately for Ketchum, pharmacist Bob Benton — alias The Black Terror — has discovered the Cacobane connection. The chemical was detected at the crime scenes (apparently it’s not so rare that police don’t test for it), and Bob realized that Cacobane was also in the termite spray he bought from Ketchum. He puts two and two together and realizes that Ketchum is participating in the robberies.

When a local hoodlum comes in to buy some more Cacobane, the Black Terror follows him to the crooks hideout.

Unfortunately, the Black Terror and his sidekick Tim are caught by surprise and knocked out. They are locked in a cage with giant mutated termites while the crooks escape. (Did I fail to mention that Ketchum also used his knowledge of chemistry to mutate and breed giant termites?) As deathtraps go, the glass-cage-with-giant-termites is pretty lame and the Terror (and Tim) quickly escape and catch the crooks including Ketchum, the failed chemistry professor/exterminator/criminal. Bob Benton — super-hero and super-pharmacist — saves the day again.

The best part of the story? This surreal panel featuring poisonous gas, giant termites, and money.

Azrael: Death’s Dark Knight #2 “Give and Take”
Fabian Nicieza, writer
Frazer Irving, artist

Michael Lane, the new Azrael, should strongly consider getting his mother into a better nursing home. A quick look at her medication sheet will show why:

Tramadol 50MG. Tramadol (Ultram) is a pain killer. 50MG is a reasonable dose.
Four times a day dosing is appropriate as well.

Simvastatin 80MG. Simvastatin is the generic name for Zocor, which is a type of cholesterol-lowering drug known as a statin. 80MG is the maximum dose. Simvastatin is a one time per day drug. Four times a day is way too often and would be extremely hard on the liver.

Lipitor 40MG. Lipitor (Atorvastatin) is another statin drug, similar to Simvastatin. She’s already on one statin — and overdosed on that one — so there’s no need for a second. 40MG is a moderately high dose of Lipitor, and just like simvastatin, four times a day dosing is three times too many. Her liver is going to be fried.

WRSI Riversound Café CD. Not a medication, but a compilation CD from radio station WRSI featuring quite a bit of good music. This strange Amazon listing is the best information on the album I can find.

Phentermine 37.5MG. In the United States, Phentermine is a Schedule IV Controlled Substance. It is an amphetamine prescribed for weight loss and appetite suppression (it was half of the infamous weight loss drug Fen-phen). It’s not a good medication at all for an elderly woman, where the usual problem is giving them an appetite, not suppressing one.

A surprisingly enjoyable episode this week. The science mumbo-jumbo was kept to a minimum and storyline kept moving quickly along.

The Plot: A mother is pushing her daughter in a stroller through Grand Central Station singing a song about a circus elephant. As they wait by the tracks for the next subway, Olivia suddenly appears and pushes the mother in front of the oncoming train, killing her. Olivia suddenly wakes from her sleep with a start, realizing she had dreamed the whole thing — until she sees the report of the suicide on the morning news.

Olivia and her team go to New York to investigate the death, but the evidence — including a surveillance tape — point to suicide. Her husband, however, pleads to Olivia that his wife would not have committed suicide. Walter suggests that possibly Olivia somehow compelled the woman to jump.

Olivia decides not to go back to sleep. She takes caffeine pills and drinks cup of coffee after cup of coffee. She finds herself in a restaurant full of happy couples. Suddenly, one of the wives starts accusing her husband of philandering and stabs him repeatedly with a steak knife. Olivia is beside her, helping her drive the knife in. Again, Olivia wakes up with a start — she has dreamed of another death. Investigating at the restaurant where the stabbing took place, the owner tells her a blond man with a scar was sitting in the booth she had dreamed herself sitting in. Reviewing the tape of the New York suicide, a blond man with a scar was there as well.

A search of governmental databases reveals that the man in question is named Nick Lane and was once a resident of St Jude’s Mental Hospital, until he came into a sudden inheritance and checked himself out. He also seems to have been familiar with the mysterious ZTF manifesto. The staff psychiatrist describes him as “hyper-emotive” — someone whose mood influences those about him. Looking through the patient’s chart, Olivia discovers that he was treated with the experimental drug Cortexiphan — the same drug she was once treated with. Walter reveals that during the Cortexiphan experiments, children were paired to reduce their anxiety. He suggests that Olivia must have been paired with Nick and a mental bond developed that allows her to dream what he is seeing. Thanks to the Cortexiphan and his unstable mental state, Nick is broadcasting his emotions to those around him. When he felt suicidal, the mother picked up his emotions and committed suicide. When he felt abandoned, the wife picked up his feelings and stabbed her husband.

Walter places Olivia under hypnosis in an attempt to locate Nick. They are able to find Nick’s apartment, but not before he has lured a stripper there and caused her to commit suicide. By the time the team reaches his apartment, Nick is already gone. Exploring his place, they find an entire wall dedicated to the Pattern. About this time, news reaches them that Nick has been spotted. He has gone to the roof of a tall building nearby and is prepared to jump to his death. He’s not alone though, his emotions are spilling so much that there are about twenty other people on the roof with him, also ready to jump. Walter tells Olivia that because she was also treated with Cortexiphan, she will be immune to Nick’s powers. She climbs to the roof and confronts him. He remembers her from the experiment, but she doesn’t remember him. He hands her a gun and asks her to kill him. She shoots him in the knees instead — he collapses and it releases his hold on the others. He tells her regretfully that someday soon, she’ll wish she had killed him. As the episode ends, Walter is watching an old videotape of the Cortexiphan experiments — a tape featuring a very young Olivia.

Not too much science to dish on in tonight’s episode, so I’m just going to go stream of consciousness here.

1. Circus Circus
According to Wikipedia, Nellie the Elephant is a perfect song to sing in order to time CPR correctly.

2. The Count
For something that was supposedly not detecting any radiation, the Geiger counter was certainly clicking a fair amount.

3. Showtime
Walter wants to see Pippin, a musical about Charlemagne’s deformed son, Pippin the Hunchback. The song he is quoting is Corner of the Sky.

4. Stripper or Not
Continuity error: When the stripper is first shown looking in the mirror in Nick’s apartment, she is topless. When the scene flashes back to her, she’s suddenly wearing a bra (what can I say, I’m a guy — I notice these things.)

5. Torre! Torre! Torre!
Just for the record: Walter mentions Nick was using the Torre attack when playing chess. Who was he playing?

6. Clues?
Thanks to some recent articles on the clues in Fringe, I’m looking for them everywhere now. I saw the light pattern in the windows in Walter’s hotel, but now I’m wondering about the 7 of clubs shown prominently on Nick’s table.

7. Continuity
Nice to see the some of the threads begin to tie together — particularly the Cortexiphan and the ZTF manifesto (both from Episode 14)

8. The Wall
I would have loved to have time to study the Pattern wall in Nick’s apartment.

An enoyable episode this week, that restores some of my faith in the show. The Doomsday clock goes back to 11:56

Junior Doctor: The patient is still unresponsive. Vitals are weak, but stable. Parents’ whereabouts unknown…

Attending: Increase the zolpidem by 50 milliliters twice a day.
Junior Doctor: Yes Doctor.

First off, Zolpidem is better known as the sleep aid Ambien.

That brings up an obvious question: why would the doctors give a sleeping pill to a patient who’s already unresponsive?

There’s actually a logical reason for that: evidence has been accumulating that zolpidem improves the state of people in comas, and may actually wake some patients from their comas. It only seems to work for certain types of coma, plus most of this evidence is anecdotal — and it’s always wise to take that kind of evidence with a grain of salt — but the idea is certainly intriguing.

Good job by Vanhook for including this appropriate yet fairly obscure medical research in the story.

Finally, a few words about the art:
There’s a very good attention to detail. IVs are in the right place (though the right IV doesn’t seem to be attached to anything), pulse oximeter is on the finger, and she’s wearing a hospital bracelet. There may be a few too many monitors, but she’s in the ICU, so who can tell?

However, a common error does surface here: patients on ventilators (breathing machines) who are drawn wearing oxygen masks. The bottom line: masks don’t work for patients on ventilators because there’s too much resistance for the air to get to the lungs. Patients on ventilators need to be intubated (a breathing tube down the throat) — or for long term patients, have the ventilator hooked up to a tracheostomy.

This episode seemed to have potential — strange creature from lab released by animal rights activists that proceeds to terrorize the countryside. But then the bad science and awkward storyline kicked in.

The Plot: A group of animal activists break into a research lab and frees all the animals from their cages. They also release a particularly nasty creature hidden in the back of the lab. The monster shows its gratitude by promptly killing one of the activists and a scientist who tried to stop them. It then hunts down and kills the other activists as they are fleeing in an SUV.

Agent Dunham and her team are called in the next morning when the wrecked car and shredded bodies are found. One of the dead bodies is moved back to the lab where Walter performs and autopsy and finds a stinger of some sort buried in the body. He also finds hundreds of larval worms in the body, apparently implanted by the creature. Unfortunately, by this time Charlie has encountered the monster and been attacked. He survived, but has become implanted with the larvae as well.

Walter has deduced that the monster is a transgenic animal — composed of the genes and attributes of multiple species. He is worried that it may be based on his work because he experimented with transgenics years before. For once, the “science” turns out to be unrelated to his research.

Walter theorizes that the only way to kill the larvae inside of Charlie is to transfuse him with some of the monster’s blood so that the larvae will get confused and stop feeding on him. The team traps the monster in the sewers and kills it, but they collect enough blood to transfuse Charlie and save his life.

1. Worry Wart
After all the other episodes where the plot was based on Walter’s research, why is he suddenly worried about the morality of it. Plenty of people have died because of his work already this season.

2. Blue Genes
Transgenic animals have been used in research for years. They are animals that express genes from other sources, or express specially modified genes. Walter seemed to be talking about transgenics taken to a whole new level — plus he was confusing it with xenografting (transplanting parts from different animals) with his talk about rejection.

“Accelerated Darwinism”
A nonsense phrase and a particularly stupid one at that. The theory of evolution applies to natural selection, and the selection here was man-made, pretty much the opposite of natural..

3. Keep the Needle Away From Me
Astrid is told to draw 25cc of blood from Charlie and she sticks the needle in the belly? She might get some peritoneal fluid, but the big blood vessels are deep in the abdomen. Why not just draw blood from the arm like a normal person?

4. Lucky Shot
Where was the incendiary part of the incendiary 50 caliber rounds? And wouldn’t incendiary rounds have made it that much more difficult to get blood from it.

5. Ultra-Special
That was impressive resolution on that out of date ultrasound machine. Even more impressive was how the picture stayed perfectly still despite Walter waving the wand all over Charlie’s chest. (That last sentence should get some interesting Google searches)

6. The Belly of the Beast
So the idea was that by giving Charlie some of Mama Monster’s blood, the baby monsters would get confused (in that “can’t tell self versus non-self” way), and thus miraculously die off (cause of death? Confusion.) So how did the proteins on Mama’s blood cells get into Charlie’s peritoneal fluid so fast, if at all? Why not just inject an anti-parasitic into the peritoneal fluid, thus bypassing most of the side effects Charlie would suffer.

7. Random Thoughts
Apparently the monster has either blue curaçao or Windex for blood.
Johnathan Swift?
Clearly Walter missed Aliens when he was in the asylum or he would have known to look up.

A mystery with potential, an interesting patient (in an annoying sort of way), and good soap opera all marred by very sloppy medicine (but at least they got the defibrillation right this time).

Doug is an environmental activist who starts the episode chained to a giant bulldozer. After being forced to leave, he stumbles around and discovers that he is unable to walk or even stand up. He sees a variety of specialists, but no one can cure him, so he is transferred to Princeton Plainsboro and admitted to House’s team.

Cameron tells the team that the “tox screen” is negative, and that there are no neurological, muscular, or cardiovascular abnormalities. House has Cameron perform a vestibular caloric test (irrigating cold water in the ear canal and monitoring any resulting nystagmus — eye twitching) to test his inner ear — the test is normal. Foreman suggests that Doug may have carotid atherosclerosis (hardening and narrowing of the carotid artery, leaving Doug at risk for stroke) worsened by stress. House orders a Holter monitor and a carotid doppler, both of which are normal. While performing the procedure, Cameron discovers that Doug has a serious case of the hiccups, and has had them on and off for a week. She realizes that his hiccups are somehow tied in to his condition. She suggests that he may have organophosphate poisoning from spending time protesting at commercial agricultural warehouses (organophosphates are commonly found in commercial insecticides). Taub counters that multiple sclerosis is a more likely diagnosis. House agrees and orders a lumbar puncture to test for the disease.

Cameron is having difficulty performing the spinal tap on Doug because he keeps moving when he hiccups. She gives him some chlorpromazine (better known as Thorazine, a potent antipsychotic which can be used to treat intractable hiccups). Then Foreman notices some swelling in his neck. At first, Cameron thinks it is torticollis (a severe muscle spasm) caused by the chlorpromazine, but House points out the neck is not just stiff but swollen. It also crunches when he touches it, a sign of crepitus, or air in the subcutaneous tissue. In this case, it comes from an “air leak between the lungs.” Sarcoidosis is suggested, but so is scleroderma, and House chooses to go with the latter, starting Doug on intravenous steroids.

Doug is lying in bed, wheezing (and this wheezing is never really mentioned or even addressed), when he develops a sudden excruciating pain in his left leg. The team decides it is likely osteomyelitis (infection of the bone) after deciding it is not a tumor, aneurysm, or metabolic bone disease. He is started on intravenous antibiotics and x-rays of the left leg are obtained. Surprise, surprise — the x-ray shows a fracture of his left femur. Cameron suggests it may be due to osteogenesis imperfecta (an inherited bone disease), but House is convinced it’s cancer. He wants to start Doug on chemotherapy. Meanwhile, Chase is surgically repairing the broken leg (because he’s an orthopedic surgeon this week), and Foreman asks him to obtain a bone biopsy at the same time. The biopsy is clear, showing no cancer. Unfortunately, Doug has bleeding problems after the surgery, with bleeding from the leg wound and purpura (a skin discoloration that is commonly seen in platelet disorders, vasculitis, and coagulation disorders) showing up on the other leg. Foreman orders 2 units of FFP (Fresh Frozen Plasma).

House is still convinced Doug has cancer and wants to proceed with total body irradiation. Instead Taub suggest that they give Doug Insulin-like Growth Factor, which should make the cancer grow larger, and thus they’ll be able to find exactly where it is. It should really come as no surprise that House agrees with this dangerous and unethical plan. About this time, Doug goes into pulseless ventricular tachycardia and needs several shocks to resuscitate him (and defibrillation is the right idea in this situation). An echocardiogram is normal, as is the troponin level (a blood test that is elevated after a heart attack). House and the team are stumped, stymied, and stuck. They have no idea what is happening to Doug. House decides to implant a defibrillator while they try and deduce what is going on. Then he his has his weekly Eureka! moment talking to Wilson. Despite being fervently anti-commercial-florist, Doug broke down once and bought his wife some roses after missing their anniversary. He caught sporotrichosis (a fungal infection) from those roses, and that’s what’s caused his problems.

As usual, major complaints are in red, minor in blue, nit-picking in green:

There are hundreds, if not thousands, of different kinds of cancer. Different types of cancer require different types of chemotherapy. What works for one cancer may not work for other cancers. There is no generic “chemotherapy” that treats every cancer — you need to know what type of cancer you are treating.

Similarly, total body irradiation only works on certain cancers — the blood and lymphatic cancers, primarily.

How exactly did the sporotrichosis make Doug unable to walk and start this entire situation? Are they suggesting he had a sportrichosis-related meningitis (a known, albeit rare, possibility), that didn’t have any affect on his mental status? They probably should have gone ahead with the lumbar puncture.

Cameron announces that Doug is free from cardiovascular disease, yet is quickly testing for carotid atherosclerosis — a cardiovascular disease.

A Holter monitor is a portable heart monitor that patients wear so that their heart rhythm can be recorded while they go about their normal daily business. It would be redundant in the hospital where all of House’s patients are already hooked up to heart monitors.

If Doug is bleeding out so much that he’s weak and fainting, a transfusion of blood might be a good idea in addition to the fresh frozen plasma.

Pulmonary sporotrichosis (from inhaled fungus) is a distinctly different form of the disease than cutaneous sporotrichosis (from superficial penetrating trauma), which is what House is describing.

His femur is broken, but everyone is focusing on and looking at his calf.

I’m suspicious that defibrillating ventricular tachycardia would be enough to raise the troponin level, at least a little bit. (From what I can find, the jury is still out on this: studies suggest defibrillating atrial arrhythmias doesn’t do much to the troponin, but multiple shocks in ventricular tachycardias do affect it).

The medical mystery itself was good again this week and deserves a B+. The final solution almost fit, but should not have been as significant a puzzle as House’s team made it, I give it a B-. The medicine was very sloppy, and even the smallest amount of research would have shown that “generic” chemotherapy was wrong. The medicine earns a D, and that’s probably generous. The soap opera was good, with Cuddy, Wilson, and Cameron/Chase all having their moments. I give it a B+.

Last week’s House review
A list of all prior House reviews

VERB was a campaign that the CDC ran from 2002 to 2006 to encourage kids age 9-13 to become more physically active. As part of this campaign, they ran a number of comic book public service ads — most of which were less than impressive.

Overall, VERB was a good campaign with a laudable goal. It had many different components, and the ads in the comics were only one tiny part of the program. That being said, I wish their comic book PSAs had been better (and I also wish the official CDC website on VERB would stop using the word “tween.” It’s an annoying enough word as it is — it doesn’t need government sanction).

For Episode 20, DrBoy had the high score with 15 points.

Overall, The Erskine holds on to the lead with 58 points, while DrBoy makes a strong push and ends up in second with 54 point. Ash and Dogma-Central are tied for third with 52 points. Harvey rounds out the top five with 50 points.

Full scores are available here.

There were two interlocking stories on tonight’s episode of Fringe. One of which contained a serial killer, and one of which contained Fringe science (if by “fringe” you mean “in no way connected to the actual laws of science”).

The Plot:A demolition crew is ready to implode an old building when one of them gets a strange feeling and runs back inside. He and his co-workers find a hidden basement that appears to have been sealed off for years, and in it, huddled in the corner, they find a naked, pale, bald ten year-old child.

Meanwhile, the serial killer known as “The Artist” has reappeared after a three year absence and sent a taunting note to the FBI.

Olivia and her team interview the strange child (hereafter called “Lex Jr”) in the hospital. He is having some shortness of breath and the doctor wants to put him on supplemental oxygen. Walter stops her and lets her know that Lex Jr is from a low oxygen environment and needs less oxygen, not more. Sure enough, Walter’s right and Lex Jr starts to breathe better. He seems to form an emotional bond with Olivia. He grabs her pen and writes a name upside down — and it turns out to be the name of the serial killer’s latest victim.

Olivia visits Lex Jr again, hoping for more clues about the killer. This time, he writes an address down for her. She goes to the address, but can’t find anything. It isn’t Lex’s fault though, it was Olivia’s: the murderer’s van was parked at that address and she missed it. While in the hospital, she meets a social worker who remarks that Lex Jr will likely be leaving the hospital soon.

Walter thinks he can provide a way for Lex Jr to talk. Olivia brings him to the lab where Walter hooks him up to the neural stimulator (remember that from episode five?). About this time, the social worker appears in the lab, only he’s not a social worker — he’s a CIA agent and wants the boy. He agrees to give Olivia and team one day to find the killer before he returns for Lex. With Lex’s help, and an assist by Peter, Olivia manages to track down and capture, if not kill outright, the Aritist. In the end, Olivia finds she can’t hand Lex over to the CIA and has the friendly doctor from the hospital set him up in a good foster home instead.

1. When is More Less?
The “Lex lived in a low-oxygen environment” concept bugged me. For one thing, if the hidden basement was that oxygen poor, the demolition crew would not have been able to breathe down there.
And later, when Walter tells the doctor to put Lex on 5% oxygen, what was the other 95%? Hospitals don’t keep tanks of less than 100% oxygen sitting around. If a little oxygen is needed, the flow setting is low. If more is needed, a higher flow (and fancier masks) are used. Remember, room air has 21% oxygen and if the team wants to go less than that, they’d need an air-tight room and would somehow have to remove the oxygen from it. You can’t just use a near-empty oxygen tank because all you’ll get from that are a few minutes of extra oxygen and then back to room air.

2. If a Bone Shatters, and No One is Around ti Hear It, Does It Still Hurt?
If he lived his entire life in the dark, he would not just be low in Vitamin D, he’d have rickets, a bone disease caused by long term Vitamin D deficiency.

3. Oxygen or Cautery
The machine they made a show of turning on before placing Lex on his “low oxygen” nasal canula had nothing at all to do with oxygen or air flow. It was the control panel for a electrocautery machine — which uses an electrical current to cut through tissue and/or cauterize wounds. It is a common piece of surgical equipment. You’ll notice the buttons were labeled monopolar, bipolar, and coagulate.

4. The Future’s So Bright, I Gotta Wear Shades
For someone with an extreme sensitivity to light, he was sure kept in a brightly lit room. How about some sunglasses at least.

5. Call the Amazing Randi
Let me get this straight: Lex can not only read the mind of the serial killer — oh sorry “empathize” with him — but he can miraculously express it in English, a language he cannot speak and isn’t even sure which way is up when he writes it (but he fixes that one fast). I could almost accept it if he drew a vague picture of what the killer was seeing, but for him to give a specific name or address when it’s likely the killer wasn’t even aware of them…

6. When Being Cheap Costs
The meat packing company sold used bloody drop cloths? And they didn’t find this strange? And The Artist didn’t have the common sense to spend a few bucks extra to buy clean ones?

7. Code
Ars Technica has a couple of nice articles (especially the second one) on “The Fringe Code.”

Big spoilers in the write up of this week’s episode of House, so don’t read it until you’ve watched the show. Overall, the medicine was good, though I would have liked to have seen more of it.

This was really an episode with a split personality. Half the episode was spent on Kutner, and only half was spent on the patient (or in this case patients) of the week. While Kutner certainly deserved the time he received, I think the medical mystery got short shrift as it had some really nice twists and turns that would have benefited from receiving more time.

Eddie is dying of lung cancer related heart failure, and is under hospice care at home. Sensing his time is near, he asks to be alone with his wife Charlotte to give her a final goodbye. In the midst of their tearful farewell, Charlotte suddenly begins gasping and struggling to breathe before collapsing. Shocked, Eddie struggles to sits up and calls out for help.

Charlotte is admitted to House’s team for evaluation of her acute respiratory failure. Her history is unremarkable except for a trip to Hawaii six months ago with her sister. Foreman suggests she may have contracted melioidosis (a tropical disease that was the culprit in episode nine) there, but the idea is dismissed in favor of Taub’s suggestion of varicella zoster (the virus that causes chicken pox; it can cause a nasty pneumonia if contracted as an adult). House wants her started on acyclovir (an antiviral drug that’s good against varicella), but she refuses treatment because she wants to be with her husband. She reports that he seemed to get better when she became sick, so it appears she will be able to spend more time with him before he dies. Taub solves the problem by wheeling her husband’s bed into her room so they can stay together.

Charlotte gets better with treatment, but Eddie starts to decline again. A short time later, Taub is called to the bedside when Charlotte starts gasping for breath. The respiratory technician tells him that her oxygen saturation is normal and it doesn’t appear to be her airway. Her lungs are normal on exam, and her heart rate, though rapid, is regular. Once again, Eddie gets better when he sees Charlotte sick. Her cardiac enzymes were normal, so that makes a heart problem unlikely. House rules out a mitochondrial disease because the vision is normal. The team then suggests a metabolic disease causing acidosis or polyserositis. House likes the latter suggestion, so starts Charlotte on indomethacin (a potent anti-inflammatory drug).

Unfortunately, Charlotte doesn’t improve on the indomethacin. Eddie, on the other hand, continues to show subtle signs of improvement. Deciding that polyserositis was the wrong diagnosis, Taub considers then quickly discards Wegener’s Granulomatosis (a disease that commonly affects the lungs and kidneys), Byssinossis (“cotton worker’s lungs” or “brown lungs” — a lung disease caused by a bacteria that lives in cotton), and mitral valve stenosis. House decides that there is only one likely diagnosis, so heads to Charlotte and Eddie’s room and confronts her. He tells her that since Eddie is improving while he is worried about her, she is faking being sick so that he will continue to improve. Grudgingly, she admits that House is correct, then she screams, complaining of left leg pain. House is doubtful, but when he examines the leg he sees muscle atrophy and petechiae, he realizes that something is truly wrong with her.

Multiple sclerosis seems a likely diagnosis, so she is sent to get an MRI of the brain to look for the telltale signs of the disease. She passes out while undergoing the procedure and is found to have a ruptured spleen. While Chase is performing an emergency splenectomy, Taub wants him to look for signs of rheumatoid arthritis. He doesn’t find any, but he does find that her liver is scarred, so whatever she has is getting worse. The team discusses and discards the diagnoses of autoimmune hepatitis and amyloidosis. House suggests alpha-1 antritrypsin deficiency (an inherited disease that attacks the liver and lungs) and orders the appropriate test (AAT). Eddie has an echocardiogram which shows he still has very severe heart failure with only a few days, at most, to live. Meanwhile, Taub has a conversation with Charlotte where she tells him that if she dies before Eddie, she would like him to get her heart for transplant. A short time later she is found seizing on the floor — she had broken into the crash cart and injected herself with all the medication she could find. She is resuscitated, but her liver has taken more damage from the drugs and she only has about 24 hours left to live. In the meantime, the AAT test has come back normal. Thirteen now suggests that Charlotte may have myelofibrosis (a disorder of the bone marrow), but mentions that the test for it takes longer than Charlotte has to live. House’s first idea is to lie to the transplant committee and say that Charlotte has myelofibrosis so she can get a liver transplant. But then he has a more devious idea. He wants Eddie to give Charlotte a partial liver transplant. Of course, a partial transplant won’t help Charlotte for long, but House understands this. He also knows that Eddie is so sick it is unlikely he will survive the surgery and will almost certainly die on the operating table, thus leaving an entire liver to transplant into Charlotte. House convinces Cameron, the “incurable romantic,” to discuss this with Eddie. He agrees to the surgery, fully realizing that he will die during the surgery, and understanding that he is dying so that his wife can receive his liver and survive.

Cameron tells House that Eddie has agreed to his plans, but she also mentions that she noticed nodules on his hands and suspects his heart failure may be caused by something other than lung cancer. House investigates and sure enough, Cameron was right. Eddie doesn’t have lung cancer, but instead a fungal infection (blastomycosis) that caused lung nodules that were mistaken for cancer, and then caused his heart failure. It is a curable disease, but Eddie is having none of it and refuses treatment — he wants to die for Charlotte so she can have his liver. Across the hospital, Charlotte is doing worse. Her fever is spiking and the lumbar puncture shows bunches of white cells (a sign of infection). Taub mentions that she is “infected everywhere.” Still unsure of her diagnosis, the team considers sarcoidosis and scleroderma. Taub then makes a comment about guilt and love, and House has his Eureka! moment of the week. It turns out that Charlotte was lying about her trip to Hawaii. She really snuck off the Rio with some other guy, and while there she contracted visceral leishmaniasis (a nasty parasitic infection of the organs, i.e. the viscera). She is started on antimony for treatment and a transplant is arranged, but it is tool late and Charlotte dies with Eddie by her side.

I don’t have any huge medical complaints this week, other than the ethics of the partial (wink, wink) liver transplant — I’m surprised Cameron agreed to go along with it. Sure, she’s the romantic, but she also been shown to have the strongest sense of ethics.

As usual, major complaints are in red, minor in blue, nit-picking in green:

Why did she improve on the acyclovir if her symptoms were caused by leishmaniasis?

House was discarding diagnosis left and right for incorrect reasons. For example:
No vision problems, can’t be mitochondrial. Wrong!
Normal thyroid, can’t be autoimmune hepatitis.Wrong!

Severe blastomycosis (like that causing heart failure — a rare situation) needs a stronger medication than Itraconazole.

It would be easier to diagnose rheumatoid arthritis with blood tests than a splenic biopsy.

It doesn’t take 48 hours to test for myelofibrosis.

Most of the suggested diagnoses fit the case better than usual this week (though most still required quite a bit of stretching); on the other hand, they also skipped over a bunch of possible causes — more than usual — probably due to lack of time.

I thought the scenes relating to Kutner were well done. His death seemed very abstract at first as it occurred off camera and the way they just showed the his legs and trunk through the doorway lent it an air of unreality. I liked the way they showed how the situation affected each character, and everyone reacted differently, though ultimately within character.

I’m sorry to see Kal Penn leave the show. He should be proud though: between playing Kutner, Kumar, and appearing in the last Superman movie, he’s completed this nerd doctor’s trifecta.

With the eminent thespian Meatloaf playing Eddie (who shares a name with the character he played in the Rocky Horror Picture Show), I hope you know how hard it was for me not to make any Bat Out of Hell Jokes in tonight’s write up.

Well, just one: Kutner may be gone, but Taub and Thirteen are still around and Two Out of Three Ain’t Bad.

Last week’s House review
A list of all prior House reviews

For Episode 18, Ben Tan and DrBoy had the high scores with 12 points.

For Episode 19, selkie had the high score with 16 points.

Overall, The Erskine takes over the lead with 54 points, Dogma-Central remains at 51 points which drops him to second. Ash in in third with 49 points, with Harvey right behind in fourth with 48 points. Tied for fifth are Erin A. and George, with 46 points each.

Full scores are available here.

Global Frequency #3 by Warren Ellis and Steve Dillon

No nosebleed this week, but a psychic eyebleed instead. In Global Frequency #3, Lana Kennedy (#884), is brought in to contain an alien meme that has already infected several blocks in New York City. In an effort to save the city, Lana attempts to write her own meme to counteract the alien one, but starts to become affected herself, hence the bleeding eyes.

All previous Psychic Nosebleed (and Eye- and Earbleed) Zen posts

Tags: comics medicine nosebleed eyebleed global frequency warren ellis meme

General anesthesia is, by and large, an extremely safe procedure that has made modern surgical treatment possible. As with any medical procedure, there are potential risks associated with general anesthesia including allergy, aspiration, and the thankfully rare malignant hyperthermia.

However, there is also another lesser known complication of anesthesia that is routinely overlooked by the medical community: Past-Life Pirate Possession Syndrome.

It all starts with an experimental anesthetic agent:

And goes downhill from there:

There is a cure, but it is difficult, expensive, and requires both a transfusion of megacyclic energy and the assistance of the Spirit of Vengeance. Frankly, preventing the condition in the first place is the easier approach.

So the next time you’re scheduled for surgery, make sure to ask your doctor if they’ve taken the proper precautions against Past-Life Pirate Possession Syndrome.

An interesting concept felled by extremely poor medicine on this week’s episode of House.

Lee is a roofer who ends up in the ER after a bicycle accident. He has suffered head trauma and appears to be brain dead, so the ER physician is ready to call the organ transplant team. Luckily, House is in the bed next to Lee after a minor motorcycle accident. He recognizes that Lee is showing purposeful eye movement so he cannot be brain dead. He realizes that lee is suffering from Locked-In Syndrome. Lee is able to communicate with House by blinking his eyes in response to yes or no questions. The hospital doctor believes that Lee’s brain damage was caused by the crash, but House suspects it was the other way around: Lee’s crash was caused by the brain damage (and Lee’s memory seems to back this up when he sees the car door but is unable to work the brakes on his bike to stop in time to avoid the collision). House’s initial differential diagnosis is fairly general and consists of stroke, cancer, or infection. The rest of his team (excepting Taub) shows up at the ER. Foreman suggests a basilar artery stroke, Kutner suggests cardiovascular disease, and Thirteen suggests a tumor. House thinks Thirteen’s idea has the most merit so he forges a set of orders for the patient to get an MRI.

The MRI is normal, though House imagines he can see a lesion in the central pons. He continues to believe that Lee has a tumor with an associated paraneoplastic syndrome. The hospital doctor disagrees and has diagnosed Lee with an infection of his central nervous system and so has him on antiviral medication (apparently suspecting a herpes, varicella, or CMV infection). The medications don’t work and Lee suffers a seizure. House reports that Lee needs plasmapheresis. Lee’s wife believes him and has Lee transferred to Princeton Plainsboro Hospital . Once there, the team discovers that he has blood in his urine. Thirteen suggests Marchiafava-Bignami Disease (a rare, progressive neurological disease seen in alcoholics). House decides that a brain biopsy is the key to discovering what the underlying disease is. In the middle of the biopsy, Lee loses his ability to blink — which was his only way of communicating. It’s not clear to the team why Lee can no longer blink — or even if he is still alive or brain dead. The worsening symptoms could be caused by a botched biopsy, brain swelling caused by the procedure, or it could be from an as of yet undetermined cause. The differential now includes Epstein-Barr virus, malaria, picornavirus or rotavirus.

Taub suggests using a brain computer interface to allow Lee to communicate. It takes some time and coaching (and pleading) by Taub, but Lee is eventually able to answer yes or no questions with the interface. While interviewing Lee about travel, his wife tells the team he had recently been in St Louis, but Lee tells House “no” to this. It turns out he lied to his wife, and was not out of town at all. At first, House thinks some hanky panky may have been going on (meaning that neurosyphilis would be a possible diagnosis), but he later learns that Lee was staying at a friend’s basement while he was cranking out resumes and applying for jobs because his roofing business was having financial troubles. The team also learns that he had been moonlighting as janitor for a local factory that made rechargeable batteries. Kutner and Taub search the factory and find cadmium dust, suggesting that Lee may have heavy metal poisoning. He is started on chelation therapy.

The chelation therapy does not seem to be working, and Lee has been frequently complaining (to himself, since no one else can hear him) of eye pain. Thirteen takes a close look with fluorescein dye (an orange dye that fluoresces green under black light if there is corneal damage) and diagnoses him with ulcerative keratitis. To House, this means that Lee either has an infection like varicella (the virus that causes chicken pox and shingles), or an autoimmune disease like Behçets Disease. Neither condition really fits well, so Cameron recommends that he perform a lumbar puncture (i.e. a spinal tap) and let the results guide his treatment. As the team is explaining the lumbar puncture procedure to Lee, he suffers a cardiac arrest. The team manages to successfully resuscitate him, but now he complains of an itching foot. To House, this mean that Lee has liver failure. When reminded that Lee’s liver enzymes are normal, he tells them that they had been high, but as the liver failure became worse and the liver died off, the levels dropped and now appear normal. He now believes that it is the liver failure which is causing the locked-in syndrome. Sclerosing Cholangitis (an autoimmune disease of the bile ducts and liver) is the team’s main diagnosis. They are preparing to perform a liver biopsy when Kutner realizes that Thirteen developed a rash where her skin had come in contact with Lee’s urine. Therefore there must be something infectious in his urine that caused her rash and Lee’s symptoms — and the likely cause is Leptospirosis. Sure enough, there were rats positive for leptospirosis in his friend’s basement. He caught the disease from them which caused his liver failure which then caused his locked in syndrome. Antibiotic treatment is started and Lee is able to move a finger again.

The concept of a patient who could only communicate with yes/no answers was clever, but the medicine was very sloppy this week.

As usual, major complaints are in red, minor in blue, nit-picking in green:

How did the liver failure affect just the one tiny portion of the brain to cause the locked-in syndrome? Why wouldn’t it affect the rest of the brain?

For the 1,732nd time: Don’t shock a flatline.
A recent study suggests bad habits learned from television medical dramas are a major reason medical students and residents are having trouble intubating patients correctly. I hate to think what that means for treating cardiac arrests…

Why was House suggesting that Lee needed plasmapherisis? It is used for treatment is certain cancers, but these are blood cancers, and nothing that fit Lee’s scenario.

It is true that in people with advanced liver failure the liver enzymes do seemingly return to normal levels. But by then, other symptoms of liver failure have been long evident. None of which Lee showed.

Liver failure can cause pruritius (itching) because of the elevated bilirubin. But it wouldn’t show up as just one foot — and the bilirubin level would be markedly elevated on the liver function test (but you notice the team only mentioned the “liver enzymes” were not elevated. Bilirubin in not a liver enzyme, though it part of the same common liver test).

Locked-In Syndrome takes a very long time to improve (not just a few days), and that’s even if the patient gets better and most don’t (actually, most die within 4 months of diagnosis).

Leptospirosis causes uveitis, not keratisis, which wouldn’t show up on fluoroscein staining.

Liver failure that advanced would probably require a liver transplant, not a few days of antibiotics.

The medical mystery was very clever, though it seemed a little too conveniently clever for its own good, still I’ll give it an A-. The final solution was an incredible stretch and earns a D. The medicine was scarcely better and earns a C-. The soap opera was only average. Taub was mildly interesting, and neither House nor Wilson seemed to have their heart in their scenes. C.

Last week’s House review
A list of all prior House reviews

scene from Trinity #37 by Kurt Busiek and Fabian Nicieza; art by Scott McDaniel

D-level villains (and that’s being generous) Punch and Jewelee are used as the focus of Morgaine’s machine to find a new Fool for her villain’s Tarot. The machine identifies the Joker as the perfect Fool — which really isn’t a surprise — but unfortunately neither Punch nor Jewelee survive the process.

SIDE NOTE: Best Punch and Jewelee appearance: Hawk and Dove #18 and #19. Also best Dan Quayle appearance, though WildC.A.T.S. #2 and #3 are close behind.

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed punch jewelee joker fool

The Yellow Plague has a great deal in common with Doc Savage’s Red Death, but it has an even more convoluted story.

The Chirrobas are a remote tribe in Latin America and their territory is the only place where the mysterious Yellow Plague occurs. The tribe’s witch doctor controls the disease, and is able to infect people as he sees fit. He also controls the only treatment.

Strangely, this disease suddenly appeared in Metropolis. Luckily, one of the interns at Metropolis Hospital happens to be a member of the Chirroba tribe and is able to recognize the disease. Before he succumbs to the plague himself, he passes on information about it and his tribe to Daily Planet reporter Clark Kent.

Clark and Lois hop on the next plane to South America. Their airship crashes, but they are able to make their way to the Chirroba tribe, where they find the chief has died mysteriously and the witch doctor has taken over. He’s had help though; Lois and Clark discover that a Metropolis gangster is backing the witch doctor’s coup. Slowly, the story comes out: the gangster and witch doctor deliberately introduced the Yellow Plague into Metropolis and plan on extorting millions of dollars to provide the cure.

As luck would have it, Superman appears in South America at the same time as Lois and Clark and is able to capture the witch doctor and gangster. He restores the dead chief’s son to the throne and in gratitude, the new chief provides him with the cure to the Yellow Plague.

From Doc Savage #9 comes “The Red Death,” another classic comic book plague.

What makes it such a great example of a “comic book” disease? How about:

• It has an awe inspiring name.
• There’s a color in the name (we’ve already met the Green Plague and the Purple Plague. Plus who could forget the Crimson Virus, Red Rain, or Kryptonian Scarlet Jungle Fever).
• It is almost instantly fatal.
• It also leaves easily identifiable marks on the skin.
• The disease is found only among certain indigenous tribes of Native Americans in Central America.
• Yet somehow, these primitive tribes are advanced enough to know how to envenom their weapons with the disease — despite having never developed germ theory.

Thanks to Doc Savage, there is also a vaccine against the Red Death, which allows Doc’s team to pull the classic fake out with nothing more than a tube of lipstick:

Though now that I think about it, it seems that the good Doctor chose not to share his vaccine with the affected tribes. Not quite what I’d call heroic behavior…

Tonight’s House is a repeat episode of the sixth episode of this season: Joy.

Full recap can be found here.

And for the record, just in case there was any doubt, the original book Starship Troopers is by far the best version of the story, so take a couple of hours and read it if you never have (or read if again if you’ve already read it). It’s one of the few Heinlein novels I actually like, though his short stories are usually very good — especially the time travel ones (All You Zombies and By His Bootstraps in particular)

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed starship troopers what, no casper van dien?

Have a little fun today, courtesy of Batman Sells Out to Claritin™:

Scene from Action Comics #190. As an added bonus, we get a doctor with a head mirror, though in this case it looks to be worn correctly.

I thought this would be a good episode of House — the last couple have been pretty good — but I was mistaken. It was surprisingly boring and the medicine was hap-hazard and illogical as well.

Morgan, a thirty-five year-old nursing home nurse comes to see House in the hospital clinic complaining of frequent colds and feeling rundown. As she is asking for some tests to be run, she suffers a tonic-clonic seizure and becomes incontinent of green urine. House decides to admit her.

The team’s initial differential diagnosis consists of infection (especially Pseudomonas) or toxin exposure. House sends Taub and Kutner to search Morgan’s office where they find a bottle of methylthionium chloride (better known as “methylene blue“), a medication that can cause green urine. Taub suspects that she has Munchausen’s Syndrome and has been faking her symptoms. Rather than admit that Taub was right, House sends him off on a fool’s errand.

House now goes to see the Morgan and pretends to induce a photosensitivite seizure. He catches her faking a seizure and she realizes it. She admits that her symptoms were fake, but insists that she is really sick. She knows that she is sick because Debbie the nursing home cat came to sleep beside her. Debbie has a reputation for only sleeping next to people who are dying, so now Morgan is certain that she is at death’s door. House is unimpressed, but then she collapses outside his office, wheezing. Foreman declares that she has bronchospasm, which both House and Foreman agree cannot be faked.

The differential now consists of bronchitis, emphysema, or visceral larva migrans (infection with intestinal worms from the cat). House suspects the latter and has the team perform a bronchoscopy (looking down the lungs with a flexible fiberoptic camera) to find any worms. The test is negative, and so now the team considers acid reflux, allergic asthma, or a panic attack. House thinks the allergy idea is the most likely, so orders a methacholine challenge (a test which provokes asthma is the patient is asthmatic). The challenge test is negative, so Cuddy tells House the he has to discharge Morgan. He takes her out to the smoking area to talk about the dissolution of her marriage and death of her step-son. While there, he notices a rash and she begins to wheeze again. He has another nearby doctor diagnose her with bronchospasm then wheels her back into the hospital. He thinks she has Churg-Strauss Syndrome (a type of vasculitis more common in people with asthma) so starts her on steroids. Morgan now develops brown urine, but there is no evidence of kidney failure, liver failure, an intestinal fistula (an abnormal connection between the intestine and bladder), or blood in the urine. Foreman suggests that the urine only looks brown because it still has traces of green dye and something is making it purple, and purple + green = brown. House thinks this means she may have a Strep bovis infection from colon cancer (about 15% of colon cancers have a concurrent S. bovis infection. The exact relationship between the two is unclear). The team reminds him that her colonoscopy was normal. He orders a pill-cam (capsule endoscopy), which is also negative for cancer.

Kutner suggest that Morgan may have a skin cancer which has spread to her colon. House has him check her over for melanomas. He finds no skin cancers, but does find prominent spider veins on her back which weren’t there before. House now determines that she has Cushing’s Syndrome (Cushing’s is caused by elevated levels of cortisol in the body. This is most commonly caused by high levels of ACTH, a chemical that tells the body to make more cortisol. ACTH-secreting tumors can most commonly be found in the pituitary gland — part of the brain — or the adrenal glands near the kidneys. House is trying to determine which is the source of the ACTH.) An MRI is negative for a tumor in the adrenals or brain, and blood levels of ACTH are equivocal, so House wants Chase to sample the blood from within her brain to see if there are high levels of ACTH there. The surgery is completed, and Morgan is found to have slightly elevated levels of ACTH in her brain. Incidentally, she also suffered a cardiac arrest while in the operating room. House decides that the cause of her Cushing’s Syndrome is an ACTH secreting tumor in the pituitary. The symptoms can be controlled with medication, but surgery can correct the problem permanently. Chase tries to dissuade her from the surgery, but she decides to have it anyway.

About this time, House has his Eureka! moment of the week when the cat comes in to his office and plops down on his laptop. He realizes that Debbie likes warm places to sleep, so she lay down with patient with fever or those on a heating blanket. She chose to sleep next to Morgan because she was giving off heat due to a carcinoid tumor hiding in her appendix. House is able to stop the brain surgery in time — and presumably Morgan has her appendix and tumor removed.

A very blah episode of House. Basically a weak copy of the themes of House versus God, with much less exciting medicine. The best part was Taub’s side story, and that — like a car crash — was painful to watch but you couldn’t look away. Poor guy.

This episode did inspire me to develop Scott’s Sign: If the cardiac arrest occurs off-camera, it’s not going to be a good show.

Their really weren’t any huge medical errors this week, but there was a great deal of confusing medicine, leaps of logic, and poorly explained reasoning. Since I didn’t have any major complaints this week, I’ll just go with minor complaints in blue and nit-picking in green:

It always amuses me when House, a show about a physician which prides itself on finding the most obscure presentation of a particular disease, limits itself to only looking for the most common causes a condition knowing it must be one of them (in this case, it was Cushing’s Syndrome having to be from an ACTH-secreting tumor in either the brain or adrenals. Sure, they’re the most common, but many other more obscure causes are known and this show thrives on obscure.)

All her MRIs and CT scans and no one ordered a scan of the abdomen, which would have found the tumor.

The purple urine/Strep bovis infection is quite a stretch. Strep bovis is one of the possible culprits in PUBS (Purple Urine Bag Syndrome — a condition seen in catheterized patients), but the evidence is far from convincing.

House seemed to be saying the Cushing’s explained the brown urine (which, incidentally, I can find no information on), but the team also told him they tested for every cause of brown urine, which would presumably include Cushing’s. So did they test or not?

Labyrinthitis is only very rarely treated with antibiotics. It is not treated with the Dix-Halpike maneuver either — Benign Positional Paroxysmal Vertigo is (though, admittedly, they do have similar presentations)

The medical mystery wasn’t given a chance to be interesting, so only earns a B-. The final solution was slightly clever, but relies on too many missed opportunities earlier, so earns a B. While there was nothing hair-rendingly bad about the medicine this week, there was nothing remotely commendable either, and so it is awarded a strictly average C. The soap opera was disappointing as well. The Taub scenes were painfully good, but the rest was just goofy. I give it another B-.

Last week’s House review
A list of all prior House reviews

from a second volume of The Amazing Spider-Man Giant Activity Pad

This one’s a little tricky because of the black-and-white-on-newsprint didn’t scan all that well.
To make it a little easier, click here to see an enlarged higher-quality image of the four spinsters in question.

This panel is a nearly perfect example of how not to use a head mirror:

1. It’s in the wrong position: way too far off to the side.

2. It’s facing the wrong way: the shiny mirrored surface should be facing inward until flipped down over the eye.

3. Doc Savage is scrubbed in and sterile, so he can’t reach up and flip down the mirror without becoming contaminated.

4. For a head mirror to work, there must be light coming from behind (or above and behind) the patient. In this case, the light source is above Doc, so there’s no light to reflect in the mirror.

(It’s not all bad: the mirror is positioned on the headband correctly so that it could be flipped down. And no, Doc isn’t wearing any eye protection, but this is long before OSHA, and no eye protection was a common practice back then.)

This is a look at the most recent Amazing Spider-Man Annual. It’s labeled #1, as well as #35, so take your pick on the numbering. This post will contain spoilers about the final fate of Jackpot, so don’t read any farther if you haven’t read the comics yet and want to keep it a surprise.

Amazing Spider-Man Annual #1/#35 “A Tale of Two Jackpots”
Marc Guggenheim, writer
Mike McKone, pencils

After Spider-Man discovers Jackpot’s true identity, he also breaks into her apartment and searches it (which is not really the best way to prove you’re not a criminal, Spidey). He discovers an entire drawerful of drugs, and realizes that Jackpot doesn’t have any real super-powers, just medically enhanced ability (but then, the same holds true for Captain America).

Later in the story, she dies of a sudden myocardial infarction (heart attack) while helping Spider-Man defeat the D-level villain Blindside. Reed Richards (the noted pathologist that he is) performs the autopsy and tells Spider-Man that Jackpot’s heart attack was caused by all the drugs she was taking compounded by the neurotoxin Blindside injected into her.

That’s pretty impressive work by Dr. Richards — he is the original über-doctor after all — being able to pinpoint the specific drug that caused the problem…since nearly every drug she was taking is known to cause cardiovascular problems:

Human Growth Hormone - Studies have shown that it causes high blood pressure, a contributing factor in cardiovascular diseases such as heart attacks. It can also cause diabetes, another contributing factor.

Anabolic Steroids - These frequently cause high blood pressure. In addition, they are known to cause increased cardiovascular disease, especially heart attacks.

COX-2 Inhibitors - A subclass of Non-Steroidal Anti-Inflammatory Drugs (NSAIDS, the same class that includes such common drugs as Ibuprofen and Naproxen). They were quite popular until a study showed that they led to an increased risk of heart attacks. Because of this, Vioxx and Bextra were pulled off the market, and Celebrex is not used as much as it once was.

Amphetamines - A study released last year showed a higher than normal rate of heart attacks in amphetamine users, even when other risk factors are accounted for.

Mutant Growth Hormone - Sadly, no good controlled studies of this fictitious drug have ever been published, so my resources are limited here. I would suspect it’s use would lead to an increased rate of heart attacks due to the increased demands on the heart for the blood needed to supply the (temporary) mutant powers. Imagine having Colossus’s metal skin without the muscles to support it.

Paracetamol - It’s interesting that Spider-Man finds paracetamol, which is the European name for what we in the United States call acetaminophen — i.e. Tylenol. It’s an over the counter pain killer, and is not associated with a risk of heart attacks, but why would she have the European version in her possession instead of acetaminophen (usually, I can blame this mistake on a British writer, but that doesn’t seem to be the case here).

For Episode 16, there was six-way tie for first for the week, with Dean, Karl Withakay, Nicki, promiscuous peach, Staci, and teatime all scoring 8 points.

For Episode 17, there was a four-way tie, with Kevin Lighton, Noether, The Erskine, and Theta Sigma all scoring 9 points.

Overall, Dogma-Central takes a decisive lead with 51 points. The Erskine is in second with 47 points. In third is Sconibulus with 45 points. Ash and Ron tie for fourth with 44 points.

Full scores are available here.

A good episode of House with a fascinating premise and some good soap opera and social moments. The medicine was average, but didn’t hurt the episode much.

Nick Greenwald is a successful book editor who, while at a party launching his star author’s latest book, finds himself blurting out truth after uncomfortable truth to those around him. He then develops a nosebleed and collapses.

Nick is admitted to House’s service where the team notes that he reminds them of the classic case of Phineas Gage (a railroad worker who suffered personality changes after a spike was driven through his brain). Nick is showing signs of frontal lobe disinhibition, but there is no sign of a frontal lobe tumor as his head MRI is negative. Thirteen suggests that there may be a tumor hidden in the nasal cavity, but a nasopharyngoscope shows nothing. Next, an fMRI (functional MRI — an MRI that looks at blood flow within the brain) is obtained and reveals an abnormal area in the cingulate gyrus. Thirteen remarks that it’s too near the brainstem to biopsy, then Foreman mentions that it might be neurosarcoidosis (sarcoidosis which affects the central nervous system). Steroids are started to treat the presumed sarcoidosis.

Nick suddenly becomes very short of breath. Foreman states that it’s not his heart because the EKG is normal, so it must be kidney failure, and starts him on dialysis.

The differential now includes systemic sclerosis and chronic lymphocytic leukemia (both of which are quickly dismissed), as well as diabetes, and some sort of “congenital genetic disorder.” Foreman points out that there are too many genetic disorders to test for them all. House has Taub run a glucose tolerance test to check for diabetes, and has Kutner check Nick’s daughter for peripheral nerve damage because she suffers from some ill-defined neurological disorder and he thinks the condition might be inherited. The peripheral nerve test is normal, and Taub reports that the glucose tolerance test was completely normal and never above 120 for the entire night. House now wants to check the thyroid, but before the test can be ordered, Nick develops a fever, coughing, and pulmonary edema. Kutner orders 200MG of furosemide (a diuretic) and 2MG of morphine (primarily a pain killer, it also helps with pulmonary edema).

With Nick’s temperature at 103° (39C), the team now considers infection as the likely cause of his symptoms. Foreman mentions Staph aureus, tuberculosis, and strongyloides (threadworm). Kutner determines that a stray dog is living with Nick’s family and he and House suspect that Nick has developed Weil’s Disease (leptospirosis — an infection caused by the Leptospira genus of bacteria). He is started on doxycycline (an antibiotic) and his condition improves. Kutner and Foreman tell him that while the infection is cured, his brain damage and disinhibition are going to be permanent. Nick wants surgery to remove the damaged area, but they tell him it is too risky. He talks to House, who apparently sees some of himself in Nick, and talks Chase into getting his boss — a neurosurgeon — to perform the surgery. Initially, the surgery seems successful, but then it quickly becomes clear that Nick still blurts out whatever crosses his mind. That’s not all though, as his temperature starts falling dangerously low and he develops unstable ventricular tachycardia (and this is the right time to use the paddles). The arrhythmia is corrected and an echocardiogram is obtained, but shows no structural heart damage. Nick continues to have an abnormal temperature. The differential diagnosis now leans toward cancer, but Foreman rather cavalierly dismisses the idea. He orders a full body scan. This shows a small abdominal aneurysm (dismissed as an incidental finding), a cyst in the pleura (the membrane surrounding the lungs — also dismissed as an incidental finding), and a density in the liver. Foreman suspects this density represnts an ateriovenous malformation (AVM) and that multiple AVMs would explain the patient’s condition. He wants to go forward with angiography with embolization (a test to find and then block off the AVMs).

House is in New York with Wilson, but the team is texting him to keep in touch. In the middle of a conversation about Wilson’s guilt over his schizophrenic brother, House has his Eureka! moment. The glucose tolerance test that was normal should not have been normal because Nick was on steroids, which raise a person’s blood sugar. The fact that it did not rise, combined with the cyst — which is really a fibroma — in the pleura means that Nick has Doege-Potter Syndrome (a fibrous tumor that secretes insulin-like compounds and causes low blood sugar; Kutner mentions human growth hormone, but other similar chemicals can also be secreted). Nick has also developed an autoimmune reaction to the tumor, and his immune system has gone into overdrive and attacked his own body (brain, kidney, heart in this case). Removing the tumor should solve his problems — the medical ones at least.

They’re really weren’t any huge medical errors this week, just the usual hodge-podge of symptoms and diagnoses that really don’t fit. The worst was Foreman’s clueless statement about cancer, so that gets the prize this week. Well, there was also that one scene, but I’ve already spent enough space talking about it.

As usual, major complaints are in red, minor in blue, nit-picking in green:

A normal PSA, normal colonoscopy, and normal blood count absolutely do not rule out cancer. Admittedly, colon cancer and prostate cancer are the most common cancers in a man Nick’s age, but there are plenty of other cancers out there (plus there are concerns about how reliable the PSA test actually is).

Diabetes doesn’t really fit his symptoms at all — other than the kidney disease. Of course, it was just an excuse to run the glucose tolerance test.
Speaking of the glucose tolerance test, the patient needs to be fasting, and it doesn’t take 12 hours to run.
It’s true that the steroids should have raised Nick’s sugars, but even a normal patient whose blood sugar didn’t rise above 120 after a hefty glucose load would be unusual.

Brain damage and peripheral nerve damage are two different things. It’s more common to have one without the other than both together.

If Nick’s kidneys are shot and he requires dialysis (a very important fact that was never mentioned again in the show; the dialysis that is, not the kidneys), then even 200MG of Lasix is not going to have any effect.

An MRI of the brain should have shown any nasal cavity tumor, especially one that was eroding into the brain.

Too many genetic disorders to test for them all? But they tested for them all in at least two previous episodes.

House doesn’t like full body scans? Then why does the team order them so regularly.

A cyst is hollow, a fibroma is solid. A scan should be able to tell the difference.

I thought the medical mystery was good this week, it was interesting not only from a medical perspective, but also fascinating from a social perspective. It made me wonder what horrible secrets I might spill. I give it an A. The solution was fairly logical, even if it did require two diagnoses (Doege-Potter + autoimmune). It earns a B+. The medicine was average for the show and I give it a C; it might have scored higher had that one scene been clearer. The soap opera was the best part of the episode. There were good House/Wilson and House/Taub interactions (the squash racket was great), and the patient’s social interactions were like a car crash: painful, but impossible to look away. The soap opera earns a solid A.

Last week’s House review
A list of all prior House reviews

The villainous Virtual Bob (yep, that’s his name) is trying to use a virtual reality program to drive Marc Slayton (Backlash) insane. Instead, Slayton turns the tables on him and uses the program to take control of Virtual Bob’s mind.

Seriously — Virtual Bob? Did he really think that was a good name? It’s an MMOPRG gesture, not a name. Frankly, There aren’t really that many awe-inspiring comic book characters who go by “Bob.” There’s Sideways Bob from DV8…and…and….hmmm. Well, there’s Bob the lizard from Grimjack. At least he’s cool.

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed backlash taboo virtual bob

Bruce Banner is lured to Europe by Victoria Frankenstein, the great grand-daughter of the infamous Victor Frankenstein. She has brought Banner to Europe to help her revive her great grandfather’s creature, who has been steadily decaying over the years. Using his superlative knowledge of medicine and anatomy (which is all the more impressive because he is a physicist), Banner helps her repair the creature. One stormy night, the full extent of her plans becomes clear when she sedates Banner and hooks him up to a machine to transfuse his gamma-irradiated blood into the creature. It is his blood, along with about a gazillion volts of lightning, that will revive the Frankenstein monster.

Her plan is a success. Not only is the monster reborn, but now he is gamma-irradiated as well. As for how the story ends, you’ll have to read the comic for yourself…

Scene from the first story in The Monster-Sized Hulk Special, by Jeff Parker and Gabriel Hardman. It’s a good, fun story — but in terms of classic monster transfusions, I still think the one where Batman transfuses a vampire is the best.

Other Comic Book Transfusions

Fantastic Four #561 “The Galactus Engine”
Mark Millar, writer
Brian Hitch, penciler

In battle, Sue Richards disables the future Wolverine by turning his optical nerves invisible, thus rendering him blind…then the Thing clobbers him.

Nice plan, but there’s no way it’s going to work.

As the name suggests, the optic nerve transmits nerve impulses from the back of the eye to the brain. It does not transmit light or images of any sort. Thus turning it invisible would have absolutely no effect on vision. It would be like turning the wiring in a lamp invisible but leaving the bulb alone — the light’s still going to work.

This is the second time I’ve seen this error in a comic book; it must be a more common misconception than I realized.

Other thoughts:
Sue can see when she’s invisible, and her optic nerve is invisible with her, so maybe she should have realized there was a flaw in her plan earlier.
Wolverine, he of the “I can smell force fields” a page earlier, is disabled by losing his vision? He defeated Sebastian Shaw by purposefully fighting him in the dark in another comic published the same month.

Medical errors — and lateness issues — aside, I am thoroughly enjoying the Millar/Hitch run on the Fantastic Four. I think it just hits all my Fantastic Four buttons perfectly.

It’s not seen in this panel, but Dakken had a similar psychic bleeding problem, so at least Xavier gives as good as he gets.

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed wolverine charles xavier

This scene raises a good question: how do you close the wounds of a man with invulnerable skin?

As I see it, there are several options:

Scene from Superman/Wonder Woman: Whom Gods Destroy, a mostly forgotten Elseworlds series from 1997 by Chris Claremont and Dusty Abell

Now, it’s not made clear in the comic if the MGH itself was exposed to gamma radiation, or if it was the mutant it was extracted from that was exposed to gamma radiation, but I favor the latter scenario because it would be a lot more fun. As if having a mutant super-power wasn’t enough, now you’d have gamma powers too. Imagine a Hulked-out Angel, Nightcrawler, or Beast…or Emma Frost.

I like the idea of stacking super-powers, and I’m surprised it hasn’t been addressed more often than the occasional Elseworlds*. (Of course, it does have its potential downside, like this)

*Some hero or other always seems to have a Green Lantern ring in addition to their own powers in those.

Flash did a version of stacking powers when he used Johnny Quick’s speed mantra in addition to his own speed powers in the Terminal Velocity storyline (my favorite Flash story ever).

Despite the barely above average medicine, I enjoyed this episode of House. Probably because it focused more on House himself than on Foreteen.

Jackson is a teenager born with genetic mosaicism whose parents have chosen to raise him as a male. He is playing on the school’s basketball team and he has just made the winning basket when he collapses to the ground with severe abdominal pain. He is later admitted to House’s service for treatment of this “chronic pelvic pain”. An issue is that his parents have never told him about his underlying genetic condition and have been giving him testosterone shots under the fiction that they are vitamins. They don’t want House or his team to tell him the truth, a situation that doesn’t sit well with some of the team, particularly Thirteen.

The team’s initial differential includes dehydration, congenital adrenal hyperplasia, PMDS (Persistent Mullerian Duct Syndrome), a blind uterus, or problems from the surgical reconstruction of his penis. House wants to perform a urethroscopy, but the parents want an MRI to look for a blind uterus. House gives into their suggestion and an MRI is ordered. The results are negative, so Jackson is prepared for the urethroscopy. As they start the procedure he starts to complain of chest pain and shortness of breath. Thirteen only hears muffled heart sounds on exam and notices jugular venous distention. He appears to be in cardiac tamponade so she jabs a syringe blindly into his chest to remove the extra fluid from around the heart.

The team’s second attempt at a differential diagnosis only yields the generalities of “drugs, toxins or infection.” Then autoimmune disease related to the testosterone injections is mentioned, especially polyarteritis or SLE (lupus). House has the team start Jackson on corticosteroids for the suspected autoimmune condition and finasteride to block the effects of the testosterone. (It’s not made clear at this point, but the testosterone injections are stopped as well). As Thirteen is administering the medicine, she notices red palms on Jackson. She takes this to mean that 1) he has does not have an autoimmune disease, and 2) his liver and kidneys are failing. Blood tests back this up (her second point, at least).

The third version of a differential diagnosis contains amyloidosis or drug/alcohol abuse due to depression. A search of his room yields some dismal and morbid poetry that Thirteen takes as proof that Jackson is depressed. She feels this depression is related to his sexual identity issues and wants his parents to tell him the truth, but his mother refuses. Meanwhile, Taub finds evidence of toxoplasmosis on Jackson’s water bottle, so infection is a possibility as well. He is started on pyrimethamine to treat the suspected toxoplasmosis. His parents ask that his testosterone be restarted as well. When Thirteen is injecting the medicine into Jackson, she confesses that it isn’t a vitamin shot like he’d been told — though she doesn’t tell him what it is, just tells him to ask his parents. This triggers a showdown with her and the parents in Cuddy’s office. Cuddy backs Thirteen, but lets her know it is for Jackson’s sake, not her own. When told the truth, Jackson understandably becomes angry and refuses to speak with his parents anymore. Thirteen comes back in to talk with him and lets him know about finding the poem. He tells her it was for a class assignment (”write a poem in the style of Sylvia Plath”), and was not about his feeling at all. He tells her that he doesn’t feel depressed — or at least he didn’t until his parents told him the truth about his genetics. He becomes suddenly nauseated and begins to vomit blood.

Jackson is found to have a gastric fistula due to necrotizing pancreatitis. Thirteen suggests Zollinger-Ellison Syndrome, but Taub believes it is systemic scleroderma. Foreman decides to treat the possible Zollinger-Ellison first and if that doesn’t work, then to treat the scleroderma. He and the rest of the team know that sclerodema is more likely, but also has a worse outcome, so they are treating the Zollinger Ellison and hoping for the best. It doesn’t work, so Jackson is started on anti-inflammatory medication to treat the scleroderma. The next morning, Foreman tells Thirteen that it is having some effect as Jackson’s liver enzymes are improving. Through some convoluted logic, they deduce that this means it cannot be sclerodema since he is getting better too fast. About this time, House reappears on the scene, hears about the case and instantly makes the diagnosis: it all started with dehydration; that’s what caused the collapse. The ER gave him some IV fluids, but because of his use if energy drinks (which apparently also caused his abdominal pain), his kidneys were slow to respond. When Jackson was then given the contrast for the MRI, the already dehydration/energy drink-strained kidneys could not filter the contrast fast enough so it cycled throughout the body, causing problems wherever it went. It was this contrast that caused the heart disease, the liver failure, the kidney failure, and the pancreatitis.

Methadone is a potent narcotic, and has more respiratory depression than more common narcotics, but it’s not that life threatening. Particularly in a patient with such a heavy previous use of narcotics.

I did like House’s realization that he can’t be the brilliant diagnostician he wants to be if he’s not in pain.

Mosaicism occurs when one person has two genetically distinct lines of cells. Some of their cells have one set of genes, and the other cells have a different set. Mosaicism generally occurs early in development, often from a mutation or nondisjunction. In Jackson’s case, one cell line is genotypically male (XY) and the other female (XX). This is a known, but rare, cause of intersexuality.

As usual, minor complaints are in blue, and nit-picking in green. My main complaint this week, the red one, I’d characterize as a “moderate” complaints — more than minor, but less than major. It’s theoretically possible, but extremely unlikely.

Intravenous contrast can certainly cause renal problems, my kidneys are proof of that. Contrast material can cause acute renal failure (contrast-induced nephropathy). There have also been isolated cases of pancreatitis and pericardial effusion thought to be linked to contrast material, but the patients involved all had significant other co-morbidities (such as AIDS). For Jackson to have had such problems with contrast, his kidneys must have been in bad shape, which should have shown up on simple blood tests — blood tests which radiologists are maniacal about ordering and avoiding the use of contrast if they looks even a little off.
I guess this sort of complication is what happens when you act as your own radiologist.
And seriously, how many energy drinks was this kid downing to cause these problems?

Notice how vague the writers were being when treating the scleroderma: repeatedly using the term “anti-inflammatories” instead of naming a specific drug. This is usually a sign that they’re trying to skirt around a known plot inconsistency.
Such as the fact the anti-inflammatory that they’d use would likely be a corticosteroid, the same type of drug they gave Jackson for a suspected autoimmune condition in the first half of the show. In fact, scleroderma is an autoimmune condition.

I like how psychic the team can be. Thirteen automatically knows it’s an exudate causing Jackson’s tamponade instead of the more common (and seen just two episodes ago) blood.
That’s incredibly fast for an exudate to form.
Blindly jamming a needle in the chest is still not a good idea. It wouldn’t take that much longer the properly position it, and just a little more time to attach it to a cardiac monitor.

Finasteride is not approved for use in children. It blocks the breakdown of testosterone into dihydrotestosterone (DHT), which I guess might help if it is the DHT causing the lupus reaction and not the testosterone itself. Otherwise, you’ve just made things worse by increasing the levels of testosterone.

Toxoplasmosis is a common parasitic disease, but does not typically cause problems in people with healthy immune systems. It is a worry in patients with compromised immune systems and in pregnant patients, because it is one of the diseases that can be passed from mother to fetus.
Symptoms don’t match at all.
Pyrimethamine is not used alone to treat toxoplasmosis. It is given with a sulfonamide.

I suspect a pelvic U/S would be a better choice than MRI when looking for a blind uterus, but then you’d avoid that whole contrast material concept.

Several hours of pelvic pain is not chronic.

The medical mystery was good. The mosaicism was a red herring in terms of the mystery itself — though it did add to the family dynamics issues. I give the mystery a B+. The final diagnosis was logical, but would have required a perfect storm of events to occur. I give it a B. The medicine overall remained haphazard, but at least it was more focused than previous weeks (except for the toxoplasmosis, that came out of left field), and earns a C+. The soap opera was fairly good, both the “House is happy” and “Mother avoids the issue” aspects. I give it a B.

Last week’s House review
A list of all prior House reviews

This week, Ron scored the most points with 8, with Asphault, Harvey, and promiscuouspeach eacg scoring 6 points.

Overall, Ash remains in the lead with 43 points with Sable Hope closely behind with 41 points. Dogma-Central remains in third with 40 points. Ron and Sconibulus tie for fourth with 36 points.

Full scores are available here.

As the Sunlight Rising storyline begins, Doc Savage decides to use his science (Science!) skills to resurrect his dead wife. Here, two of his companions discuss the plans.

Unfortunately for Doc, he’s basing his resurrection plans on an untruth. It’s a myth that the hair and fingernails grow after you die. While they may appear to grow, what is really happening that the skin next to them is dehydrating and shrinking, giving the illusion of growth.

Doc proceeds with his planned resurrection, but his equipment is stolen by the villains who use it to resurrect his more-or-less archenemy, John Sunlight.

Recently, I’ve been reading through DC’s Doc Savage comic book series from the late ’80s. It features the titular hero brought forward into modern times and having his usual world-spanning adventures. As to be expected from a character who got his start in the pulp magazines of the ’30s and ’40s, the stories are chock full of improbable — if not downright impossible — science (or should that be Science!). Since I’m a fan of the old pulps, I’m willing to accept these in the spirit of the times.

Sometimes, though, I run across a scene where the science is just a little too mad…

So…the “magnetic ray” exerts a force on the iron in the blood (I can buy that), but this somehow causes the pulse to race, the blood pressure to skyrocket, and then the heart to explode. I’d be interested to know how the hemoglobin in the red blood cells has that powerful an affect on the heart, since normally it exerts exactly zero influence on it. I can’t even conceive of a mechanism how this would work. A racing heart could certainly raise the blood pressure, but other severe problems would occur (severe sudden heart failure, a fatal arrhythmia, a stroke, or a heart attack) long before the heart exploded. This is another example of trying to explain things too much — they should have just left it at “magnetic ray.”

Of course, I do appreciate the fact that I get to add another entry to my “Things Which Cause Nose Bleeds in Comic Books” list.

This episode of House started off great with an intriguing medical mystery, but over the course of an hour it degenerated into a barely mediocre episode.

Daniel Bresson is a burned out alcoholic priest currently working at a small inner city church. After he shuts the sanctuary for the night, he retires to his dingy one-room apartment and proceeds to drink and smoke the night away. A few drinks later, he hears a knock on the door and angrily gets up to answer it, only to discover that waiting at the door for him is Jesus, stigmata present, floating a foot of the ground. The next time we see Daniel he is at the Princeton Plainsboro ER. Cameron has decided he is probably just suffering from alcohol abuse or exhaustion, and is surprised when House decides to take the case and admit the patient. It turns out that House doesn’t think Daniel has anything significantly wrong with him either, he is just looking for a “fake patient” to prove a point to Foreman and Thirteen.

After informing his team about Daniel’s admission, House suggests psychomotor epilepsy (an older term for temporal lobe epilepsy, particularly the complex partial seizure variety), atropine toxicity, or a frontal lobe tumor as possible causes of the hallucination. Taub suspects it was the alcohol. House orders an EEG, a head CT, and a search of Daniel’s apartment. The EEG and CT are normal. The apartment search takes a while to finally get started, but reveals nothing as well. While performing the tests, Taub and Kutner learn that Daniel has been transferred around different churches across the nation because a teenager once accused him of “inappropriate contact.” Daniel swears he is innocent, but Taub thinks he is lying and suggests that his symptoms may be caused by syphilis.

As Kutner and Taub get ready to discharge the patient — as they could find nothing wrong with him — he mentions that he is feeling nauseated and his left foot is numb. Examining the foot, Kutner discovers that one of Daniel’s toes has turned black and fallen off. House now suggests leprosy, ergotism, or carbon monoxide poisoning. He seems to favor the latter and orders a carbon monoxide blood level, as well as starting Daniel in a hyperbaric chamber. While in the chamber, he begins to feel a crushing chest pain and the team is suspicious he may have had a heart attack, but the EKG is normal. House proposes that Daniel may have a clotting disorder and orders what seems to be an entire body angiogram to look for clots. None are seen, but the team discovers that Daniel has large areas of his body that are entirely numb. Daniel also takes this moment to mention that he has become blind in his right eye. House now believes his problem to be a neurological one. Autoimmune is mentioned (particularly Guillain-Barre) as a possible diagnosis, as are tumors and infection. House then dives into a metaphor about Duran Duran as his way of suggesting that the problem probably lies in the patient’s spleen. He orders a spleen biopsy. The results are normal, except for “insignificant traces of minor bugs.” One of these bugs turns out to be Pneumocystis, which is only seen in patients with a compromised immune system. The team suspect AIDS. Daniel refuses an HIV test, informing the doctors that he knows he cannot have AIDS as he does not have any of the risk factors. After some arguments among the team, House decides to start him on HIV therapy regardless.

As Kutner is hanging the medicine, Daniel’s condition begins to deteriorate. His blood pressure climbs, he begins to feel flushed, and a rash breaks out on his chest. The differential now consists of a reaction to the HIV medication, hyper IgE syndrome, another genetic syndrome, or cerebral microtumors (tumors too small to show up on standard scans). Genetic testing is ordered to look for the cause of his symptoms. House has his weekly Eureka! moment while talking with Wilson. He realizes that the hallucination that brought Daniel to the hospital in the first place was alcohol induced — and after excluding that, the remaining symptoms lead him to conclude that Daniel is suffering from Wiskott-Aldrich Syndrome, an inherited disease.

As usual, major complaints are in red, minor in blue, nit-picking in green:

This is the first episode in quite a while where House himself is suggesting most of the differential diagnoses — and he’s not very good at it (at least in this episode). The vast majority of his diagnoses — including the final one — require tremendous leaps of logic and the ability to gloss over inconvenient symptoms that don’t fit.

Taub can rule out pneumonia, pleurisy and an embolus just by fluoroscope? The pneumonia I can accept, but pleurisy doesn’t show up on a scan like that, and how could he rule out a clot since they only rarely show up on x-rays, and Kutner hadn’t even started injecting the dye yet?

If the patient had low white count, I wouldn’t think of the spleen first thing, or even second or third. There are other more likely causes that don’t require a risky and likely uninformative spleen biopsy.

Traces of other diseases (&ldquomild bugs”) can be found in the spleen? Really, how is that? And they can be easily tested? (Unless they are somehow referring to antibody memory cells.)
Now, assuming for a moment Thirteen is correct, Pneumocystis is a very common germ. Pretty much everyone has come in contact with it and their immune system has easily fought it off. (It only becomes a problem in people with low immune systems.) Bear in mind that even these healthy people would show “insignificant traces” of a minor bug so the test tells us nothing, certainly not that the patient has AIDS

Is House suggesting the team test for every genetic disorder?

Non-medical nitpicks:
They move the priest back to the same city as his alleged victim?
Foreman’s job hunt — even with a letter of recommendation — didn’t go so well last time. That’s why he ended up working under House again.

The medical mystery was good. It started off well, even if it was a fake out, and maintained interest through the episode. It earns a B+. The final diagnosis was quite a stretch, Wiskott-Aldrich appearing suddenly in 29 year-old who had been previously healthy? Maybe a family history would have been a nice thing to obtain. I give the solution a C-. The same for the medicine (C-) which required too much coincidence and skipping over symptoms. The soap opera was good on every front and deserves an A-.

Last week’s House review
A list of all prior House reviews

The second good episode of Fringe in a row. Maybe my Doomsday Clock threat is working

The Plot:The episode starts with Mr. Jones, the enigmatic villain who escaped from a German prison several episodes ago through the use of Dr. Bishop’s teleport machine. He was shoved in a decompression chamber the minute he arrived, and now he finally emerges 2 weeks later. Everything should be fine, but he notices a distinct tremor of his hands.

Meanwhile, a newspaper vendor in the city dies in a particularly gruesome way. In a matter of seconds, his skin grows over his eyes, nose, and mouth and he suffocates to death. On first hearing about the case, Bishop suspects ceramides were involved. Agent Dunham, on her part, suspects that Mr. Jones is behind the death and is determined to find him.

One of the junior FBI agents determines that Jones’ late lawyer had access to a warehouse in Texas that, after years of lying dormant, had its power switched back on the same day Jones escaped from prison. Broyles is just about to order a raid on the warehouse when Mr. Jones turns himself in to the FBI at the Boston office. He refuses to speak to anyone but Agent Dunham.

For once making sense, new head honcho Harris refuses to let Dunham talk to Jones, telling her that doing so would be giving in to a terrorist’s demands. Instead he sends Dunham on the raid on the Texas warehouse. The raid turns up evidence that Jones had been there, and when one of the FBI agents (coincidentally, the same one who located the warehouse in the first place) dies of the same weird condition, the team knows Jones is responsible for the strange disease.

Dunham and Peter Bishop track down the manifesto of the ZTF, the group Jones is associated with. It tells of a coming war between two realities with only one surviving. By now, Dr. Bishop has discovered that the strange disease is caused by toxin absorbed through the skin that causes hyperactivity of the “protein responsible for scar tissue.”

Back in Boston, Jones refuses to talk to Harris, but does give him a list of supplies he requires. Dunham returns from Texas and meets with Jones. She hands him the supplies he requested and he promptly uses them to make an anti-surveillance device so no one can overhear their conversation. He admits that he is responsible for the two deaths, but tells her he wants to prevent any more. Before giving her anymore information, he tells her that she must take the key he brought with him and take it to an abandoned amusement part. Once there, she finds what appears to be a box of old children’s games. A note tells her that she must pass the “first test” — mentally turn off all the lights in a box — with her mind alone before Jones will tell her anything else.

Dunham tries the test, fails, and is convinced it is nothing but a game Jones is playing. She confronts him again, and he tells her it is not a game, but reality. He then tells her that she is special because she received treatment with the drug Cortexiphan. It turns out that this is a drug designed by Massive Dynamics — by Dr. Bell himself in fact — which is supposed to “remove limitations” from the mind. During their conversation, Jones collapses, suffering from after effects of teleportation; effects which are hinted at, but never explained. He is rushed to Bishop’s lab where Dr. Bishop manages to resuscitate him. Dunham has Peter Bishop rewire the light board so it looks like she passed the test. Jones relents and tells her the location of a bomb containing the compound that causes the disease. The FBI rushes there to find that the bomb is wired with an array of lights, just like the “test” Dunham was given. The only way to defuse the bomb is turn out all the lights without touching the device. Olivia decides she has to try and manages to mentally turn off all the lights with just seconds to spare.

Afterward, when she goes to talk with Jones, she discovers he has escaped the hospital where he was transferred by punching an enormous hole in the wall. The words “You Pass” are scrawled on the wall. Meanwhile, Walter has been reading the ZTF manifesto and discovers that its typewritten pages exactly match the print produced by his old typewriter.

1. Would a Fat-Free Diet Help?
Ceramides are lipid molecules common in cell membranes. As Walter says, they play a role in cell differentiation. On the other hand, he’s mostly wrong when he also mentions cell growth. Ceramides don’t seem to play a role in overactive cell growth — just the opposite actually — they appear to inhibit cell growth. (And being a lipid – a fatty molecule — it has nothing to do with the scar tissue protein implicated later).

2. Not Quite Far Enough
Performing her emergency tracheotomy, Agent Dunham successfully cut through the skin, but neglected to actually cut into the trachea — the key part of the procedure. She just slid the tube into the loose tissue in front of the trachea — though it ended up being a moot point.

3. Rescue Me
Unexplained bradycardia. An EKG is a good call.
They confused cardiac arrest (the heart stopping) and heart attack (lack of blood flow to the heart causing damage). Nitroglycerin is good for a heart attack, but won’t do any good for a cardiac arrest.
50cc is not enough saline to resuscitate anyone; it’s only about 1 ½ shot glasses of salt water. A normal resuscitation required liters of fluid. Though to be fair, Walter orders the saline and never states why; it is Peter who tells us it is for resuscitation, and he might not know what he’s talking about.

4. Lying or Stupid?
Mr Jones didn’t tell Olivia “where or when” the bomb was going to go off? He may have neglected the where, but he certainly told us the when — 16 hours.

5. Elementary, My Dear Watson
Some interesting choices for the movies and book mentioned in this episode. I’m suspicious they may be clues, or at least hints.
The Land of Laughs. I actually have the book in my library (but not the edition shown). A very good book. Among other themes, it deals with reality versus fantasy. Since they explicitly singled out the book by name, I suspect it’s important. I’ll have to reread it.
Charade. Good movie. Cary Grant, Audrey Hepburn. Deals with people who aren’t what they seem. Good guys are bad guys and bad guys are good guys.
Rear Window, the only Jimmy Stewart/Grace Kelly movie. A classic Hitchcock suspense thriller.

There were hokey aspects (Dunham’s psychic powers, alternate realities) and questionable medicine, but there was enough cleverness in this week’s plot to allow me to overlook them. I particularly liked the manifesto and the twist that the bomb had to be deactivated just like the test she only beat by cheating. I’m moving back the clock another minute, and the Doomsday Clock now stands at 11:55. (Of course, now we have to wait until April for new episodes, and I will have forgotten all the clues and the show will have lost all its building momentum.)

Detective Comics #693 “Systemic Shock”
Chuck Dixon, writer
Staz Johnson, penciler
Published January 1996

I hope everyone looked at the Arkham Asylum Employment Application, because this scene follows immediately from that image and gives you good reason not to trust Poison Ivy’s cooking (like that isn’t common sense).

Psychiatrist #1: And you grew these greens on the grounds?
Poison Ivy: And strictly organic, doctor.
Psychiatrist #1: I love fresh radishes.
Psychiatrist #2: Um…they’re tangier than I’m used to.
Psychiatrist #1: Mmf…Chmmf…They’ve got a real bite to them. Almost like–
Psychiatrist #2: FFT! [choking sound]
Psychiatrist #1: WFFT! [choking sound]

Jack in the Pulpit (Arisaema triphyllum) is a common forest plant in the western half of the United States. It is well known for its unique flower that looks like a preacher standing in a pulpit (hence its name).

Native Americans used Jack in the Pulpit as a food source, but they were careful only to consume the plant once it was dried or cooked. The raw plant is extremely irritating to the mucous membranes of the mouth and throat. It contains calcium oxalate crystals — which are extremely irritating to the tissues of the mouth causing swelling and a burning pain. Mild mouth or throat irritation is the most common, but there have allegedly been cases where consumption of the raw plant has led to a severe swelling of the throat, causing the victim to asphyxiate (which is what seems to be happening here. Poison Ivy seems to have found an uncommonly potent variety). If swallowed, the plant can also be extremely irritating to the stomach, causing nausea, vomiting, and severe abdominal pain; it is said to have caused deaths in this manner as well. According to my most reliable medical botany text, human deaths from Jack in the Pulpit are just rumored; there have been no confirmed deaths from eating the plant.

There are a couple problems with Poison Ivy’s plan (besides her lucking into finding an extremely toxic variety of the plant): While eating raw Jack in the Pulpit causes irritation of the mouth, gums, and throat, the irritation is on the inside of the mouth. The cheeks won’t swell up like a puffer-fish. Pushing a narrow straw through the lips won’t help anyway because –
1) It’s the throat swelling that’s cutting off the airway, not the lips.
2) The straw is too narrow for good air exchange (which seems to be a common comic book theme).

Before Superman perfected his “keep the heart beating with heat vision” technique, it appears he experimented with other resuscitation methods including this one, which he used to restart Professor Hamilton’s heart in Action Comics #667.

This technique seems to involve rubbing the chest very fast and…um…OK, I actually have no idea what Superman’s trying to accomplish here. But it sure seems to work — maybe it will show up in the next revision of ACLS.

Actually, I think that Superman’s powers would work against him in a resuscitation situation:
1. Super strength: It’s be too easy for him to apply a little too much pressure and crush the ribcage.
2. Super speed: He’d have the tendency to compress the heart too fast. CPR requires steady measured beats. With his speed, he’d essentially be mimicking ventricular tachycardia, if not downright ventricular fibrillation.

So if you’re down for the count and a super-hero shows up, you better pray it’s Batman and not Superman — I bet he’s got a Bat-AED in that belt of his.

Sorry for the late scores, but social obligations stole most of my free time over the past week.

This episode, Gerritt scored the most points with 15, while both Staci and tina earned 12 points.

Overall, Ash takes the lead with 42 points and Sable Hope drops to second with 40 points. Dogma-Central remains in third with 37 points. The Erskine rejoins the top scorers with 34 points, and Sconibulus and JockM tie for fifth with 33 points.

(The two people with missing points from last week had their scores updated as well)

Full scores are available here.

From week to week, it seems to vary: Agent Dunham is shown as either very competent or very lucky, and this was an episode favoring luck over skill. Despite that, I thought it was one of the better episodes of Fringe.

The Plot: A passenger on an airline flight notices a sudden nosebleed. He goes to the restroom, checks himself out in the mirror, and then runs a test on his saliva. When the results comes back positive, he is mortified. He rushes out and tries to convince the stewardess and steward that unless he was given some sedatives immediately, everyone on the flight will die. This, unsurprisingly, does not sit well with them. He retreats back to the bathroom where he transforms into a giant porcupine-sasquatch that proceeds to attack the other passengers and terrorize the plane, which shortly crashes into a field.

Agent Dunham and her team are called in to examine the wreckage of the crashed flight. The porcupine-man’s body is found and taken to Bishop’s lab. The good doctor finds “evidence of an extradural hematoma, probable epistaxis” and a glass disc embedded in the victim’s hand (similar to the disc found in the Jell-O Bus episode).

Agent Dunham looks through the passenger manifest and by using Agent Scott’s memories is able to identify the victim. She also identifies a suspicious person among his contacts, Daniel Hicks. When Hicks is brought in for questioning, his nose begins to bleed just like the original victim’s. Before he succumbs, Dunham is able to get a name out of Hicks: “Conrad.” Luckily, Dr. Bishop is there and orders the man be sedated and brought to his lab where he is placed in medically induced coma to slow the transformation. Bishop recognizes that a designer virus is to blame, and is able to concoct a antidote — but isn’t completely sure it will work.

Broyles tells Dunham that Conrad is a mysterious developer of biological weapons that law enforcement agencies have been trying to capture for years. As coincidence would have it, he is due to arrive in Chicago any day now to complete an arms deal for the virus in question.

Seeking information, Agent Dunham goes back into the isolation tank to delve into Agent Scott’s memories. Scott sees her there — though he shouldn’t be able to — and tells her that he was a deep cover agent for the NSA trying to catch Conrad. The two victims of the virus were also deep cover agents. He tells her to trust Hicks.

Dunham orders Hicks to be brought out of his coma and given the antidote. Through an undetectable two-way radio, he is going to guide her through an arms deal with Conrad. She and Peter Bishop fly to Chicago and manage to bluff their way into a meeting with Conrad’s men. Everything goes well until the antidote stops working and Hicks starts to transform again. Bishop has to sedate him to keep him alive. Peter does some fancy verbal footwork, but eventually their deception is exposed. No worries though, because they are able to summon the nearby FBI agents rescue them as well as capture Conrad.

As the episode ends, Dunham goes back in the tank a final time to say goodbye to Agent Scott.

1. Identity Issues
If the victim’s DNA was “completely rewritten,” (Peter’s words) how were they able to identify him through his blood?

2. I Swear, It’s For My Attention Deficit Disorder
I wonder how much dextroamphetamine 30cc is, since Dr. Bishop doesn’t give a concentration. 30cc is a hell of a lot of fluid to inject into somebody — it would hurt like hell, if you were able to get it all in (for reference, 30cc is a shot-glass full of liquid; a usual injection is less than 1cc).

3. Viral Nosebleed Zen
Even if the victim has a bleed around their brain (the “extradural hematoma”), it wouldn’t be able to leak out into the nose unless the skull was also fractured. (FYI: “Epistaxis” is fancy medical talk for “nosebleed”).

4. I Think Walter’s Lab is the Second Level of the Inferno
If I were Walter and autopsying a mysterious porcupine-sasquatch, I would be wearing a mask at the very least.
Walter has the equipment to keep someone safely in a medically induced coma in his lab?
Midazolam is better known as Versed, and is a short acting intravenous sedative from the same family as Valium.

5. The Return of Some Old Favorites
Once again, conservation of mass is an issue. Where did the matter to make all those spines and increased muscles come from?
And I’m not even going to mention the retained-memories from John Scott scenes — well, other than this.

Despite the isolation tank scenes and the return of Massive Dynamic, I enjoyed the episode more than I expected. I thought the arms deal in particular was handled well and gave off a palpable feeling of suspense. I’m giving Fringe a bit of a respite, and moving my Fringe Doomsday Clock back a little: the clock is now showing 11:56.

Comic book writers have a tendency to try to tie everything together in a neat little package. Depending on your point of view, this can be a good or exasperating (I tend towards the former). I find it particularly interesting when writers take this approach when dealing with comic book medicine. A good example is what I like to call the “Venom Family Tree.” In it, we see 60+ years of comic book continuity linked by the drug Venom.

NOTES:
1. Miraclo is the pill that gives Hourman his power and was first mentioned in Adventure Comics #48 (March 1940). In JSA All-Stars #5 (Nov 2003), Hourman II revealed that he had made a new non-addictive version of Miraclo that worked via a skin patch. In JSA Classified #17-18 (November 2006), it was revealed that Venom was based on Miraclo.

2. Venom is an addictive super-steroid that was first mentioned in Legends of the Dark Knight #16 (March 1991). Side note: it wasn’t called Venom at that time — that was the name of the storyline. It is best known for giving the super-villain Bane his power. There have been at least a second- and third-generation of Venom, each more powerful and more addictive than the last.

3. Decahydrabolin, better known as Steroid A39, is the drug that gave the current Dr. Mid-Nite his powers. In Doctor Mid-Nite #1 (1999), he mentions that it is a derivative of Venom.

4. Slappers are a transdermal version of Venom that appeared in Batman Beyond, so are undoubtedly non-canon.

5. Nandrolone is a real-world anabolic steroid. In Nightwing #114 (January 2006) it was mentioned as a precursor of Venom.

I’m pretty sure I’m missing a few more Venom derivatives, but I’ll fill them in as I run across them again. Some day, when I have way too much time on my hands and I’m feeling masochistic, I’ll take on the Super Soldier Serum family tree.

The 100th episode of House. Too bad it was so absolutely mediocre with an unlikable patient.

Of course, this also makes it my 100th House review*. Sure the first reviews were just a paragraph or two, but they quickly evolved into the behemoth you see before you now. While it’s certainly true that the quality of the show has suffered some over the past few seasons, it still remains the best medical show, if not best show outright, on television.

Dana Miller is assisting a chef in teaching a cooking class when she becomes short of breath and starts to cough. She discovers that her lips are blue and realizes she has cyanosis. She complains of pain in her chest and back and diagnoses herself with a spontaneous pneumothorax before collapsing on the floor. She is rushed to the hospital and admitted to House’s service, primarily based on her name and reputation. It turns out that Dana is a rock star in the world of the cancer research, and said to be on the cusp of finding a cure for retinoblastoma. The team is sorely disappointed when she tells them that she gave up her career in medicine eight months ago after uterine surgery because she realized it wasn’t making her happy. She now devotes her time only to activities that she fully enjoys.

There is no clear cause for Dana’s pneumothorax. Foreman points out that there is no history of COPD (chronic obstructive pulmonary disease, i.e. emphysema) and no history of tobacco use or recent scuba diving. The initial differential diagnosis consists of cystic fibrosis, lung cancer, or an undiagnosed asthma. She is started on steroids to treat the suspected asthma and a CT scan of her lungs is obtained to look for evidence of hyperinflation (a sign of asthma). The CT scan is normal, making asthma less likely. Taub suggests that lingering damage from the central line from her surgery might explain the lung problem (and I couldn’t help but notice that instead of just stating she had “surgery,” he was very specific about which surgery she had. Hmmm. Wonder if this will be important later?). Kutner notes increased interstitial markings on the CT scan — which apparently everyone else missed — which means that Dana might have pulmonary fibrosis. A biopsy is ordered. When Taub is explaining the test to her, she starts to complain of left-sided abdominal pain. After a quick exam, Taub tells her she has bleeding into her abdominal cavity and withdraws a syringe of blood to prove it. (FYI: She asks if she has ascites, the build up of fluid in the abdomen).

In addition to her lung problem, Dana now has a liver problem — or problems — as well. Not only is her liver bleeding into her abdominal cavity, but they also work in the fact that she has liver failure. Foreman suggests a liver granuloma as a possible cause, and Thirteen goes one step farther and suggests blastomycosis as the cause of the granuloma. A biopsy is obtained, but the test for blastomycosis is negative. Dana starts to complain of itching, which she blames on the liver failure (the high bilirubin levels that occur in liver failure can definitely lead to very bad itching). As she sleeps, she continues to scratch, and in fact scratches hard enough that she scratches through her skull into her brain. Luckily, Taub is able to repair the skin damage (having a plastic surgeon on the team is sure handy) and announces that she has suffered no brain damage.

The differential now consists of psychogenic itching, meningitis, encephalitis, multiple sclerosis, or a brain tumor. An MRI of the brain is obtained and is negative. House now suspects that Dana has polyneuropathy and wants to shock the affected areas to “reboot” the nerves. As Taub is about to start the treatment, she begins to experience a shocking sensation — which he identifies as Lhermitte’s sign. According to the team, this can be suggestive of Behçets Disease, Vitamin B12 deficiency, a demyelinating disease, or a spinal hemangioma. An MRI is ordered to look for a hemangioma. It turns up what appears to be not just a single hemangioma, but hemangiomas in the spine, lungs, and pericardium (the sac surrounding the heart). The thought now is that she has metastatic mesothelioma (a lung cancer most commonly associated with asbestos exposure), but House is perplexed that these same lesions did not show up on the chest CT two days before. Wilson is called in to biopsy one of the lung lesions, but he is unable to perform the procedure as the lesion starts bleeding profusely, which should not happen if it is mesothelioma. He suggests she might have arteriovenous malformations (AVMs) due to schistosomiasis (a parasitic infection acquired from bathing or swimming in contaminated water), but the team counters that she shows signs of Gorham’s Disease or Kasabach-Merritt Syndrome. The brainstorming is interrupted when Dana suffers cardiac tamponade (blood fills the pericardial sac, compressing the heart and not allowing it to beat correctly). Kutner inserts a needle (read: jams a needle blindly) into her chest to relieve the tamponade, only now she is bleeding copiously through her ears, nose and eyes.

Later, Taub informs House that they are giving Dana multiple units of platelets and FFP (fresh frozen plasma) but they cannot control her bleeding. House suggests embolization — blocking off the bleeding blood vessels. He wants them to start with the ones in her lungs. He then proceeds to run into Cuddy, where in the midst of a crasser than normal conversation, he has his Eureka! moment. He reveals that Dana is bleeding so heavily because it she is menstruating. He announces that as a result of her uterine surgery she has developed endometrosis, and it is these abnormal clusters of endometrial tissues throughout her body that are doing the bleeding.

Thirteen begins to have frontal headaches. Foreman is concerned that it may be related to the experimental Huntington’s drug, but she blows it off, telling him that she has been taking the drug or the placebo for weeks now, and nothing has changed recently (Right? Right? Wink wink.) House then brings her lack of peripheral vision to Foreman’s attention. He tests her himself and finds that House is right. He confesses the truth that he switched the drugs to her, and obtains an MRI of her brain. It reveals a tumor in the optic chiasm. Within a day or so, she becomes totally blind. House and Foreman give her a directed radiation treatment to the tumor, and it regresses and Thirteen’s sight is restored. As the episode ends, Foreman confesses what he did to the drug company running the trial. He is kicked off the trial, but gets to keep his license. On the other hand, Thirteen’s data, now considered dirty, is excluded from the trial and so is the evidence that the drug may cause tumors.

As usual, major complaints are in red, minor in blue, nit-picking in green:

I had pretty much given up on even mentioning the errors in the procedures the team performs, but this week two scenes were so bad that they bear special mention.
First, Taub drawing the blood from the abdomen. He did just about everything wrong. No protection for him. God forbid he sterilize or at least clean the patient first (congratulations Taub, you just gave her a staph infection of the abdomen). You need to use a z-track technique or the higher pressure in the abdomen will push the fluid out the needle track. That 20- or 40-cc syringe was way too small to draw off any appreciable amount of fluid. I have seen multiple liters pulled off a single patient (though admittedly, those patients looked pregnant).
I have similar complaints in regards to Kutner’s technique for pericardiocentesis. Worst was when he overhand jabbed the needle blindly into her left chest. That is NOT the way to perform a pericardiocentesis. He likely gave her a second pneumothorax, not to mention injured the heart or sheared off a coronary artery. The trick is to drain off the fluid without killing the patient in the process.

There have been documented cases of endometrosis being spread due to surgery, however, in all these cases the patients had endometriosis before surgery, and it was that endometriosis that was spread, not normal endometrial tissue that became endometriosis.
My biggest problem with the endrometriosis solution is the time course. Remember your high school health class. The endometrium takes 3 -3½ weeks to slowly build up in thickness before sloughing off to start the menstrual cycle. Endometrial tissue does not go from nothing to suddenly-detectable-everywhere one day before the cycle starts. If she that much endometriosis to cause all the symptoms she had, there would have been plenty of evidence on the first CT.
Why had she been symptom free the previous 7 months?

Bronchoscopy and bronchoalveolar lavage are the preferred initial steps in diagnosing pulmonary fibrosis. It’s true that they are not as good as an open biopsy, but the risk pf complications are significantly less.

There are many fungi that fluoresce under black light and it is a fun way to diagnose ringworm, but it is not the recommended method of diagnosing blastomycosis. In fact, I didn’t find the technique mentioned in any of the main texts on the subject.

Wow, Thirteen had an incredibly fast growing tumor, didn’t she?
I was amazed at how fast the writers were able to turn it around from “Foreman screwed up” to “Those evil drug companies!”

“House was right” about the hemangioma? I though Taub was the one who brought it up.

I don’t know too many oncologists who do their own lung biopsies.

What explains the liver failure?

Other than the comic-book style shocking visuals, why was Dana bleeding from her ears, nose and eyes? Did she have endometriosis there too (a first), or was the pressure of the bleeding so much it split her skull?

The medical mystery was fair this week. It started out small, but built up over the course of the episode and earns a B. Though I had problems with the final diagnosis medically, I thought it was clever and with a little tweaking could have fir perfectly so deserves another B. The medicine was average again: very superficial with little follow through. It earns a C. The soap opera was good, if understated. I liked the book-ending Wilson scenes, and the House/Cuddy scenes were fun, if a little out of character for her (though she did explain she had been dragged down to his level). I give the soap opera a B.

Last week’s House review
A list of all prior House reviews

*OK, technically it’s my 101st House review as I re-reviewed one of the earlier episodes. One of these days, when I have time, I plan to go back and do the same for the other early episodes.

Ultimate Fantastic Four #59
Joe Pokaski, writer
Tyler Kirkham, penciler

When I read the solicitation for this issue of the Ultimate Fantastic Four, I had high hopes. A Fantastic Voyage style adventure into Sue Storm’s brain? Sounds great! Unfortunately, the book didn’t live up to my expectations. Now don’t get me wrong: it’s not a bad comic — unlike many recent comics it actually advances the plot and has good characterization — but all the same it’s a frustrating comic because it could have been so much now. Plus there’s a handful of questionable medicine.

Sue Storm has been unconscious since using her powers to save New York City from a tsunami wave in Ultimatum #1. Not only did this give her a psychic nosebleed, but it also knocked her into a coma. Not a normal coma, but one that can only be corrected by zapping a specific area of the hindbrain known as the “Omega Synapse” (cue dramatic music) with a laser. Of course, this must done from inside her body. Since Reed Richards is nowhere to be found, Ben Grimm recruits disgraced scientist Dr. Arthur Molekevic (aka the Mole Man) to help him. Together they jerry-rig a space shuttle with a laser and a Pym-particle-based shrinking device, then hop in and begin their voyage.

Grimm and Molekevic start by flying in the mouth and down the trachea, because Molekevic assures Grimm that it is way it’s always done. It’s a little hard to tell it’s the trachea by the art, because it lacks the ring-structure normally seen in the trachea . Frankly, it looks more like the esophagus. Luckily, sensing my confusion, the artist has drawn lots of air lines, so we know it’s the trachea (or else Sue’s inhaling a lot of tiny worms). Plus there’s a caption.

Next, another caption identifies the shuttle as being in the carotid artery, but the dialogue indicates they’re heading toward the heart. If both are true, then that’s a very bass-ackwards way to get to the heart if the ultimate destination is the brain. Another comment a few pages later indicates that they are just then heading out for the carotid, so I think it’s safe to say the caption is wrong (it should probably read pulmonary vein).

Since the shuttle’s in Sue’s circulatory system now, at some point they must have crossed from her airways into her blood vessels, but how or where is never explained (or even mentioned). This is probably just the doctor/sci-fi geek in me talking, but I would have really liked to know how they did it. Personally, I’m assuming they crossed over in the lungs, because that’s the most logical location.

Molekevic: The brain is the destination, but we have to go through the heart to get there. It’s Grand Central Station. The good news is we can get pretty much anywhere from here. The bad is that the tissue us extremely sensitive and will reject anything foreign or artifical in — well, a heartbeat.

That must be shocking news for the thousands of people with artificial heart valves, not to mention the hundreds of thousands of people with pacemakers.

While in the heart, the shuttle is attacked by hundreds of tiny insectoid robots. The Thing heads outside to fight them off.

General Ross: What’s happening Dr. Storm?
Dr. Storm: She’s gone into cardiac arrest.
Ross: And where are Grimm and Molekevic?
Storm: From the look of it, they’re putting the attack in heart attack.

That is either a confused scientist or a very bad joke. Cardiac arrest and heart attack do not mean the same thing. A cardiac arrest indicates that the heart has stopped (i.e. “arrested”). It can be caused by a heart attack, but it can also be caused by other things such as an arrhythmia (bad heart rhythm), direct trauma, or blood loss. On the other hand, a heart attack occurs when one of the tiny coronary arteries (the arteries which supply blood to the heart muscle itself) is blocked. Some of the heart muscle dies, causing a heart attack (myocardial infarction in medical terminology). Large heart attacks can be immediately fatal, but smaller ones can occur undetected.

The shuttle heads out of the heart and towards the carotid arteries and the medulla oblongata. Somewhere along the way they cross into the cerebrospinal fluid (the liquid surrounding the brain) — and once again I’d like to know how; the blood-brain barrier is tough to pass. The carotid is also not a very good route to get to the hindbrain, but maybe the goal was just to get into the cerebrospinal fluid and then float down to the medulla. The Omega Synapse (cue music!) is located and fried with the laser. Unfortunately, the robot insects have followed them and the battle continues. During the fight, the shrinking machine is injured and Grimm and Molekevic have to quickly leave Sue’s body before they return to normal size within her.

Sue survives, as do Ben Grimm and Arthur Molekevic. For better or worse, Dr. Storm and General Ross also survive.

A very low scoring game this week.

Nekolux has the weekly high score with 5 points. Bryan Wang, Kirsten, and TRad all earned 4 points.

Overall, Sable Hope remains in the lead with 40 points. Ash moves in close with 39 points. Dogma-Central drops to third with 37 points. Sconibulus remains in fourth with 33 points, and JockM stays in fifth with 32 points.

Full scores are available here.

Another week, another episode of Fringe with painfully bad medicine — only this time with bad computer science as well!

The Plot: A teen age boy is on the computer when he open an anonymously sent program. Strange images begin flickering on the computer screen and he stares, transfixed. His parent find him later, dead, his brain liquefied and oozing from his ears and nose.

Agent Dunham and her team arrive on the scene. They interview parents and friends, but can find nothing incriminating. The grab his computer and take it back to the lab. Astrid tries to look at the hard drive — after all, she has a minor in “computer science” — but announces that she cannot because its platters are fused.

A second body is found, just like the first. This time, it’s a car salesman across town. The computer hard drive shows the same damage, but this time Astrid is able to determine that he had downloaded a shortly before he died. Peter takes both computer hard drives to one of his friends who is not able to track down the sender of the file, but is able to discover that it has been sent to a new location — Agent Dunham’s home. Dunham and Peter rush to her apartment and find her young niece transfixed by the screen. They are able to bring her out of the trance and she appears fine. Dunham does notice that the webcam light is on, suggesting that someone has been watching her.

Another victim is found, this time a day trader in Evanston, Illinois. The killer has gotten sloppy and there is enough information for even Agent Dunham to discover a pattern to the killings. This victim was the new husband of the mother of Luke Dempsey. Luke was the first victim’s best friend. Dunham discovers that Luke’s father is something of an incredible computer genius. She suspects he is the one behind the murders. She brings Luke in, but he won’t tell her where his father is. She lets him go, and follows him to his father’s hideout. She confronts the killer, but in the end he takes his own life.

1. Brain Fondue
Dr. Bishop: A complex combination of visual and subsonic aural stimuli, ingeniously designed to amplify the electrical impulses of the brain, trapping it in an endless loop.
That sure sounds like Dr. Bishop is describing a seizure, or actually a type of potentially fatal seizure known as “status epilepticus“.
People can die from status epilepticus, but their brain doesn’t liquefy.
Speaking of that, how exactly did this seizure-like activity cause the brain to liquefy? Was it supposed to raise the temperature so much the brain melted? That’s really too stupid for words.
And even if the brain did liquefy, why would it leak out the nose and ears? The brain is essentially in a tightly sealed container; it won’t leak out unless the container is broken (a skull fracture, for instance).
Flashing lights can certainly cause seizures in certain people; it’s called a photosensitive seizure and was the reason that one episode of Pokemon was never shown on television in the U.S. But it doesn’t cause seizures in people who aren’t already susceptible.

2. The Brown Note
My speakers can barely play real sounds, let alone “subsonic aural stimuli.”

3. Damn Viruses
Astrid: A computer virus that infects people.
I thought this idea was ridiculous when I first ran across it several years ago in the Cable/Deadpool comic book. Plus, I don’t think this was an actual computer virus. It was malware, certainly, but it didn’t have the self propagating characterstic of true computer viruses.
Yet another reason not to click on spam pop-ups.

4. The American Medical Association
There is no such thing as the “AMA Database.” The AMA is essentially a lobbying organization, it has little to do with the actual practice of medicine.

5. It Didn’t Even Start Well
That is an absolutely horrible episode title.

6. All Your Base Are Belong To Us
I know just enough about computers to realize that most of the “computer science” on this week’s episode was on par with the medicine. I leave it up to all you computer experts to do the critiquing here.

I’m afraid Fringe is rapidly reaching the point where it has gotten so ridiculous that it’s not worth an hour of my time to watch, let alone write about afterward. To this end, I have created the Fringe Doomsday Clock, patterned after the famous nuclear doomsday clock.

When the clock reaches midnight, my patience will be up and I will stop watching Fringe. After the last two episodes, the clock has been moved ahead to 11:57.

A much better episode of House this week. While it wasn’t quite up to the standards of the first two seasons, there were definite that classic House was trying to break through.

Sarah is a 29 year old teacher of special needs children who suddenly begins to cough up blood during class and then collapses. She is admitted to the hospital under House’s care. The team’s initial differential diagnosis includes ulcer, leukemia, von Willebrand’s disease (a blood clotting disorder), or a thoracic tumor. House agrees with Foreman that the problem is likely within the patient’s blood and orders a bleeding time test. The test is abnormal, showing that her blood is not clotting correcting. A check of her clotting factors is normal, but her platelets turn up abnormal. The differential diagnosis now includes lymphoma and ITP (idiopathic thrombocytopenic purpura), with the latter being more likely. House elects to start her on methotrexate (which really isn’t a recommended treatment for ITP), but he also wants to treat her with total body irradiation (which is also not a recommended treatment for ITP, only it can have even nastier side effects than methrotrexate). In actuality, House has no intention of using the radiation but is just trying to test Cameron’s limits. She calls his bluff and allows the procedure, so now House and his team pretend have to pretend to use it. In the meantime, the methotrexate has shown no benefit, so House doubles the dose and adds Prednisone (a steroid, and the actual recommended treatment for treating ITP). During the (fake) radiation treatment, Sarah mentions that she has to pee. When she tries to get off the table, she collapses and is found to be pulseless. Thirteen and Taub rapidly pull out the defibrillator and shock her back into a normal rhythm.

The team meets again to discuss the latest findings. Tests, including a transthoracic echocardigram and a bubble test, show no structural defects of Sarah’s heart. Thirteen suggests a high vagal tone from urinating may have caused her to develop an arrhythmia and collapse. The rest of the team half-heartedly suggest heavy metal poisoning, toxin exposure, drug use, or alcohol use. Thirteen then mentions cold agglutinin disease, which seem to fit the case. House wants to put Sarah in an ice bath to test the diagnosis, but Cameron wants him to test some of the blood first. Reluctantly House agrees. The blood clots when exposed to the cold, confirming the presence of cold agglutinins, so Sarah is put into a three minute ice bath. The test, though uncomfortable, is normal (so while she may have some cold agglutinins — and most people do at various levels — she doesn’t have the disease; but please note this is not the recommended way to diagnose the condition).

House now decides that Sarah’s offhand story of transposing the digits of her room number, combined with her need to urinate during the radiation treatment, are signs of a brain lesion — a left hippocampal lesion to be precise. He thinks it is most likely multiple sclerosis (MS), and wants to perform a brain biopsy to confirm his diagnosis. Kutner thinks she has a pancreatic tumor and wants to perform an ERCP instead, but House wins — sort of. Cameron won’t let him go through with a brain biopsy, wanting an MRI first. Reluctantly, House orders the MRI, but it is normal, so Sarah doesn’t have MS. Kutner performs his ERCP and it is normal, but Sarah starts to have problems breathing during the test. She is found to have pleural effusions (fluid build up around the lungs), which are drained (off camera). House now decides that Sarah has equine encephalitis, a mosquito-borne disease caused by a picornavirus (there are actually several types of equine encephalitis, but none that I can find are caused by a picornavirus), which is causing conduction problems in her brain. He wants to test nerve conduction tests along the surface of her brain. This, of course, requires removing the top of her skull and thus needs approval from Cameron. She declines. Meanwhile, Kutner now thinks that she has a lymphoma of her spleen and wants to perform a splenectomy (surgically remove the spleen). House has Thirteen and Foreman search the classroom for evidence of encephalitis, but they turn up nothing significant. Nevertheless, Cameron allows him to perform the nerve conduction study and even assists. The test is going smoothly until Kutner tattles by calling Cuddy. She demands to speak with House and is placed on speakerphone. In the background, her baby Rachel is crying, and the sound is annoying Sarah quite a bit. Her reaction is paradoxical, though, in that her blood pressure drops while she is annoyed (it should rise). The team ends the test and puts her skull back together. House is puzzled and cannot figure out what is going on with Sarah. Puzzled, that is, until Cuddy and Rachel stop by. The baby spits up on House which leads him to start a monologue about evolution which leads him to have his Eureka! moment and diagnose Sarah with a PDA (patent ductus arteriosus).

As usual, major complaints are in red, minor in blue, nit-picking in green:

Even though the PDA may not have been open when the heart was scanned, the fact that the duct still existed (it should have withered away) should have been evident.
Why would only the left part of her brain been affected?

Apparently no one in the hospital likes to run CT scans or MRIs (this week anyway). Most of the diagnoses mentioned (MS, lymphoma, tumor) would have shown up and not required brain biopsy, ERCP, etc.

A blood test for cold agglutinins is not simply a “cool the blood and see if it clots” test, but a test to see how much it clots.
An ice bath is by no stretch of the imagination a good test for cold agglutinin disease, if they have it, you’ve just done the patient a major disservice as systemic clotting is not a good thing.

ITP, by definition, has low platelet numbers — which were never mentioned, just abnormal looking platelets (though her red blood cells should have looked chewed up as well).
MTX is not a treatment for ITP. It has been investigated, and continues to be investigated, but hasn’t shown a lot of promise. IV steroids are first line.

There seems to be confusion among the team about heart attacks (myocardial infarctions) and cardiac arrest. The terms are not synonymous.
Shocking a pulseless patient? How about — at least — some CPR first, if not checking the rhythm before shocking?

If I were the doctors I would have taken a closer look at the vitals during the test. Her resting oxygen saturation was 97% — on oxygen. That’s not normal. Nor is a heart rate of 116 , even though they called it “normal”. It didn’t change at all during her ice bath, when it should have shot up. Sure, I know the fancy vital sign machine was just there as a prop, but at least put in a little effort to make it authentic, prop people.

It would have been nice if they had run labs on the fluid they pulled out of the effusion. It would have helped to rule out cancer and pancreatic disease at least.

On another note, parent/baby bonding is often delayed in adoption situations and post-adoption depression in common, so what Cuddy was feeling was fairly normal. I’m glad to see she did not give up Rachel because of it.

The medical mystery started out weak (coughing up blood? That’s it?), but got better earns a B. The final solution was a stretch, but at least it fits more symptoms and seems more logical than usual and thus deserves a B+. The medicine had too much jumping from diagnosis to diagnosis while overlooking the most common and useful testing, so can’t really be considered anything more than average: C. The soap opera was subdued this week, but that felt appropriate, and earns a B.

Last week’s House review
A list of all prior House reviews

Detective Comics #619 “Rite of Passage, Part Two: Beyond Belief”
Alan Grant, writer
Norm Breyfogle, penciler
Published August 1990

Tim Drake’s parent’s have been kidnapped and a mysterious tape sent to the Gotham Police demanding a ransom. Batman notices a faint odor on the tape and uses it to help track down the criminals.

Batman is at least partially correct. Jimsonweed (aka Thornapple, Devil’s Trumpet, Ditch Weed; scientific name Datura stramonium) is thought to have originated in Central America (though some experts suspect India) and spread from there. Now it is a ubiquitous plant found worldwide, not just Central America. In fact, the name Jimsonweed is thought to be a corruption of Jamestown Weed, another name of the plant, and proof it was found in Virginia from the early days of American history. Here’s a map of the plant’s distribution in the U.S. alone.

More proof that the drug is known worldwide: it shows up several times in the manga Apothecarius Argentum.

Over the years, medications made from Jimsonweed have had a number of uses. Most well known, as Batman notes, was its use in treating asthma. The 1899 Merck Manual mentions stramonium (a medical name for Jimsonweed) when discussing the treatment of asthma:

Unfortunately, the line between a safe dose and a toxic dose was very thin when dealing with Datura and there have been quite a few deaths attributed to its use. For this reason, the FDA declared it “unfit for human consumption” and it is no longer used medicinally in the United States — but I suspect it is still used in a number of third world countries. Jimsonweed is also used by some people as a recreational hallucinogen, but again it is extremely easy to accidentally take a toxic dose.

Another interesting fact about Jimsonweed is the plant’s rumored use in the preparation of zombies. Also known as “Zombie Cucumber”, Datura has long been suspected as one of the drugs used to turn people into zombies. We’re talking the classic Haitian zombies here, not the modern brain eating ones. Since the Drakes’ kidnapper is a Haitian medicine man, this Haiti-Zombie-Jimsonweed connection is undoubtedly intentional, if unnoticed by Batman.

This episode of Fringe introduced a new antagonist as well as new protagonist/hostage, and also features some spectacularly bad medical science

The Plot: Agent Dunham had been kidnapped at the end of the previous episode. As this episode begins, she is strapped down to a gurney by her captors and ends up on the receiving end of a spinal tap. We manage to catch a glimpse of one of her abductors: Agent Loeb (from episode 7). Dunham manages to escape, and in the process steals some suspicious looking test tubes.

Dunham calls in reinforcements, but the FBI agents who show up subdue and tranquilize her. It turns out that there is an internal affairs investigation into the FBI “Fringe” office, and it is being headed up by an investigator who bears a grudge against Agent Dunham. Tranquilizing her was his way of letting her know who is boss.

Meanwhile, a world-famous immunologist is lecturing at Boston College when he suddenly starts choking and collapses. A giant slug-like beastie emerges from his mouth and escapes into the auditorium. Agent Dunham and her team are called in to investigate. She determines that the late immunologist was asked to head a secret CDC task force concerning epidemics. Another local doctor has also been asked to serve on the committee, and he is brought in to protective custody by Dunham. It’s all for naught though, as Agent Loeb kills him by dosing his water with giant slug eggs.

About the same time, Walter discovers that it is not actually a giant slug, but a gargantuan cold virus. The samples Dunham stole from her captors are some of the (for lack of a better term) slug eggs.

Dr. Bishop: It’s viral — nasopharyngitis — albeit a gargantuan specimen

Thanks to his poor shoe-related hygiene, Agent Dunham has now realized that Loeb is a turncoat. She heads to his house to see if she can find anything incriminating, and she does find some suspicious documents, but she also finds his wife. A catfight breaks out that ends with Olivia shooting and killing Loeb’s wife. Meanwhile Charlie asks Peter’s help in setting up a tap on Loeb’s phone. They finish just in time to hear Loeb tell his wife to kill Agent Dunham. Peter calls Dunham to warn her and that’s what sets off the catfight.

In the end, Agent Loeb is captured and when informed his wife has been killed, admits that he murdered the two scientists. When asked about abducting Dunham, he replies that he wasn’t trying to kidnap her, but instead to save her.

There wasn’t all that much science in this one, but what there was hemorrhoid-inducing bad.

1. No Virus I Ever Met
A gargantuan cold virus? Nonsense. It is physically impossible for viruses to grow that large. There are many reasons for this; for starters, here’s the square cube law.
Furthermore, they kept confusing a virus and a cell, which are two entirely different things. A virus is much smaller than a cell — it just consists of some nucleic acid (DNA or RNA) and a handful of proteins. Because it is not a cell, comparing it to giant cells means nothing.
Nasopharyngitis is not the name of a virus, it is the name of a condition: a runny nose and a sore throat, i.e. a cold. Cold viruses are typically rhinoviruses or adenoviruses.
How could it have grown so big so fast?
There are certain parasites that protect themselves in hard-walled cysts that breakdown when exposed to stomach acid, allowing the parasite to become active — so that part is not too far fetched.
Decongestants treat the symptoms of the cold (or more accurately the symptoms caused by the body’s reaction to the cold virus). They wouldn’t have any effect on the virus itself.

2. Cover Up the Slide’s Title Next Time
Simian Hemorrhagic Fever is a real disease, but it (like most hemorrhagic fevers) is a viral disease. The slide Walter was looking at was clearly labeled leptospira, a bacteria that causes (wait for it) leptospirosis. The “intricate web” he was talking about was just a bunch of the leptospira bacteria. Look at the picture on Wikipidia, it’s pretty much identical.