Polite Dissent

Time to revisit another favorite topic: nosebleeds.

Susan Storm develops nosebleeds twice while projecting her forcefield in the “Doom” storyline in Ultimate Fantastic Four. She’s a young, healthy, and fit individual — so why is she bleeding?

Is it due to mental strain? Unlikely. Mental activity, strain, and concentration do not lead to nosebleeds. If they did, colleges and high schools would be filled with bleeding students during finals week.

Is it due to physical strain? Again, unlikely. Watch the Strongest Man in the World competitions on ESPN2. Those guys are physically straining as hard as they can for several minutes at a time. Veins are popping, eyes are bulging, but there’s no nosebleed in sight. On the other hand, people who have already have weakened blood vessels in their nose may be susceptible to bloody noses from strenuous activity, but there’s differing medical opinions about this.

What about elevated blood pressure? Possible, but unlikely. There’s also conflicting and unclear data about the relationship between nosebleeds and high blood pressure. As far as I can tell from a quick read of the literature, people with nosebleeds tend to have a higher blood pressure, but people with high blood pressure don’t necessarily have more nosebleeds.

What about trauma or infection? A definite possibility. Susan could have gotten clocked during a fight with the Mole Man and his subterranians in the previous storyline. She also could have caught a cold while down in the dank tunnels, which irritated the nasal mucosa leading to nosebleeds. (Or she could pick her nose enough to cause bleeding — now that’s a cover I’d like to see Greg Land draw.)

So if you must have a medical reason for Sue’s nosebleeds, I suggest that she got hit in the nose during the fight with the Mole Man, and the physical strain of projecting her forcefield was enough to burst an already weakened blood vessel.

Of course it’s far more likely is it’s yet another example of nosebleeds being comic book shorthand for a character “straining really hard using their mental powers.”

As others have pointed out, you’ll notice that in the recent Fantastic Four movie, Jessica Alba’s Susan Storm also develops a nosebleed while using her powers. Wonder if it was the same nostril?

For more thoughts on comic book shorthand and nosebleeds, check out the tags below…

Tags: comics medicine nosebleed comic book shorthand fantastic four

Anybody going to Emerald City ComiCon this year? Both the Polite-Wife and I have some vacation time coming and we thought we’d head out west for the convention. (The usual bribe will be offered to the Polite-Wife in return for her joining me at a convention: a nice dinner out while we’re in Seattle. Suggestions are welcome.)

Tags: comicon

Hawk & Dove #16 is essentially a battle royale between the forces of Chaos, led by Hawk, and the forces of Order, led by DOve, who are defending Arriya’s citadel. Both Hawk and Dove are confident, probably overconfident, that they can defeat the other. The forces of Order and Chaos are both using a magical substance known as tridic metal which the user can mentally shape into a variety of weapons. The Order forces are using it to craft traditional weapons such as swords, staves, bows, and shields. Hawk, however, has out-thought them all, and has used the magical metal to create attack helicopters, military rifles, and bazookas. In no time at all his army is winning the battle.

Dove flies out to confront Hawk and convince him to see things her way. It’s a wasted effort as Hawk has no intention of listening to her. In the end, he takes a dive off a bridge at the top of the mountain just like he was doing cannonball in the local pool. He crashes to the ground at the foot of the mountain. Thanks to his invulnerability he is able to walk away unhurt, but the shockwave topples the citadel and most of the mountain. The forces of Order have lost and Chaos has won.

In addition to the epic battle between Hawk and Dove, there are several other important events in this issue.

• The Lord of Chaos M’Shulla taunts Rome, the head priest of the Order goddess Arriya. He gleefully informs Rome that the priest’s whole religion is based on a lie: Arriya has never heard his prayers because Arriya is not her true name. There is a Goddess of Order for Druspa Tau, but generations ago M’Shulla cast a spell to make everyone forget her true name — and until that true name is spoken, she cannot return.
  
• Ren is starting to fight back against her possession by Kestrel and stops him from killing innocents during the battle.
• In a climactic final scene, Rome encounters Barter. It seems that Barter knows Arriya’s true name and offers it up to the old priest (though what the priest has to trade in trturn is never stated). Within minutes, her true name “Terataya” is being spoken throughout Druspa Tau, and in the clouds overhead Unity — the combined form of the Terataya and her lover the Lord of Chaos T’Charr– return to their rightful world.

Tags: comics hawk dove kestrel .

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I’d be remiss if I failed to point out that Brian Cronin’s Comic Book Urban Legends Revealed #36 over at Comics Should Be Good deals with an issue concerning Hawk & Dove #5 (the 1988 mini-series) and the art by Rob Liefeld.

Tags: groundhog comics

It’s my birthday Saturday, so I’ll be taking the weekend off.

I’ll be back on Monday.

This ad starring Meatloaf appeared on the back cover of Marvel comics in 1987 (this scan is from New Mutants #57). It’s for a good cause — the International Special Olympics — but this has to be one of the worst PSA ads ever. (Click on the image for the full ad)

• First, is it Meat Loaf or Meatloaf? He seems to prefer the latter former, but this ad goes with the one-word moniker, so I’m going to stick with that.
• Meatloaf’s tagline in this ad is “Humongous Rock Star of the Universe.” Does “Humongous” refer to his popularity or to his size? Given the fact that this is ten years past his magnum opus Bat Out of Hell, and five years before the derivative-yet-still-listenable Bat of Hell II (not to mention his role as a bouncer in Wayne’s World), I suspect it refers more to his girth than his crowd drawing ability.
• His left hand is fingering some bizarre chord on his guitar, a guitar that seems to be pointed straight out at the concert audience. And where is his right arm? All I can figure is that he’s somehow reaching back and strumming the guitar behing his back.
• Does anybody really want everything Meatloaf’s got?
• Maybe if he wasn’t onstage under bright lights in an orange duster he wouldn’t be sweating as much. Or maybe he’s just crying, it’s hard to tell.
• Apparently, there’s no crime going on in the Marvel universe that night and all the heroes decided to show up to the concert, in costume, even Thor ( “Forsooth, methinks I will enjoy the vocal stylings of this minstrel known as Loaf of Meat. By Odin’s Beard — he doth be Humongous!”)
• The art makes him look more like Tiny Tim and less like Meatloaf.

Links:

• The single “A Time for Heroes” actually sounds pretty interesting. It was sung by Meatloaf and Brian May from Queen. An instrumental version was also perfomed by Tangerine Dream.
• Lyrics for “A Time For Heroes”
• Guitar tabs for “A Time for Heroes”
• The CD-single version of A Time for Heroes is available on eBay. Going price is £14.99 (just over $26, US) — not counting shipping and handling, of course. The poster of this ad is also available on eBay.
• This Wikipedia article on meatloaf got a laugh out of me.
• Emeril’s recipe for meatloaf. And Alton Brown’s.

Tags: comics psa meatloaf

This medical review of House contains spoilers galore, so don’t say I didn’t warn you…

Margo Dalton is a driven woman. She is an involved mother, a career woman, and a charity organizer. She is taking fertility treatments so that she can have a child with her second husband. Suddenly one day, she develops a sudden movement disorder: uncontrollable twitches and spasms of her muscles, mostly in her limbs, but also involving her face. She is brought to the hospital for evaluation. Cameron suspects it is due to increased estrogen from her (unnamed) fertility treatments. Foreman thinks it is Huntington’s Disease (also known as Huntington’s Chorea, a particularly nasty inherited condition leading to movement disorders and dementia), while House suspects it may be a side effect of pregnancy.

The pregnancy test is negative and an MRI is obtained which shows no brain injury. While her young daughter is visiting, Margo becomes suddenly very irritable and has a full psychotic episode a short time later, suffering violent paranoid delusions.

The genetic test for Huntington’s comes back negative, and House is wondering about Margo’s “spontaneous schizophrenia.” Toxins are considered as a possible cause, as are drugs. A search of her car turns up a bottle of Ritalin which she reluctantly admits to taking. House believes the problem to be solved, so Margo is discharged from the hospital but has a stroke on the way out. Ultrasounds are obtained of the heart, arms, and legs to look for a source of the clot that caused the stroke, but all the tests are normal (but notice that no ultrasound was obtained of the carotid arteries, a frequent source of stroke-causing clots). The team now becomes concerned that Margo has a uterine cancer that led to her stroke (cancers cause the blood to clot easier, which makes clots and strokes more likely). A uterine ultrasound is normal, but House wants an endometrial biopsy performed. Before the procedure even begins, Margo begins bleeding uncontrollably and is discovered to have a vascular tumor in her liver. House determines that Margo has secretly been taking birth control pills so she won’t become pregnant despite being on fertility treatments; she doesn’t want to tell her her husband she doesn’t want another child. These birth control pills have led to her stroke and liver tumor. In the end, rather than admit the truth to her husband, Margo elects to have the tumor removed surgically.

This was another episode where the writers violated Occam’s Razor, a rule they emphasized in the first season (in fact, one of the first episodes was named Occam’s Razor). Put simply, Occam’s Razor suggests that the simplest solution is generally the right one; if a patient has multiple symptoms, the diagnosis that explains them all is most likely correct. This is the second episode this season where three separate diagnoses were required to explain the patient’s symptoms, about as far from Occam as you can get. The sad thing is that in this case the third diagnosis was completely unnecessary. Any treatment that raises the estrogen high enough to cause movement disorders is also going to place the patient at risk for blood clots and liver disease. The fertility medication could have explained the movement disorder, stroke, and liver tumor. In fact, now that I’ve taken a moment to look it up, psychosis has also been associated with fertility treatment, so that alone could explain all of Margo’s symptoms. (Yes, I know the Ritalin and birth control pills were required to show how driven Margo is and how she keeps secrets from her husband, but from a medical mystery point of view, both were redundant).

Annoyances:

• Ritalin is a controlled substance. You don’t get “three refills in three weeks” without somebody noticing.
• Treatment with Clomid (which I’m assuming is the unnamed fertility treatment, as it fits the description the best) is recommended for no more than six months, not thirteen months.
• The OR scene annoyed me as well. Chase is handed the tumor, looks at it under the microscope, and determined that it is not malignant. First, where was his sterile technique? The microscope wasn’t sterile yet his hands were all over it. If he didn’t need to be sterile (and he probably didn’t), then why was he scrubbed in? A specimen also needs to be specially treated before it can be examined for cancer (usually rinsed with a special stain and sliced less-than-paper-thin with a special machine). You just don’t plunk it down and take a gander at it.

The soap opera was hot and heavy this week. House and Stacey both seemed to have enjoyed their flirtation and kiss in Baltimore and end up in bed this episode. Stacey is ready to leave her husband for House, but in the end House calls it off. He says he’s stopping the affair because it won’t work and her husband is better for her than House, but Wilson suspects that House just likes to be miserable. A second soap opera plot involved Cameron’s HIV test (after she was exposed to infected blood in a previous episode). The test was negative, but House put her through hell to find out.

This episode earns an A for the mystery, but only a C for the solution because too much logic was sacrificed for story, resulting in a B for the medicine overall. The soap opera aspect earns an A-.

• Previous House reviews

Tags: television medicine house stroke huntington’s.

When writing my House review yesterday, I was trying to find a website that provided a good layman’s explanation of what a controlled subtance is. I never found such a site and ended up posting a ink to the overly verbose and legalistic Controlled Substance Act itself.

When I Googled “controlled substance”, I was fascinated by the ad that accompanied the results. Apparently, they will sell anything on eBay.

(For the record, I clicked on the ad and it took me to auctions for radio controlled cars and other items with “controlled” in the title. Not quite the same thing.)

Tags:medicine ebay controlled substance

Tags: comics x-men valentines

Tags: comics legion of super-heroes valentines

Spent most of the weekend watching the Olympics, from the opening ceremony (a Ferrari doing donuts? What the-) on. I did take a break for the NASCAR Bud Shootout, a short race at Daytona with a field limited to racers who won a pole last year and past winners of the Shootout. Random thoughts follow.

Olympics:

• Women’s Olympic Hockey is hockey perfection. You can actually see the skill and fluidity that make hockey a compelling sport, and not jst the brute-fest it has become in the NHL.
• I can’t say I’m disappointed that Bode Miller didn’t win. I’m glad that Chad Hedrick and Shaun White won.
• Ice skaters performing to Led Zeppelin. Never thought I’d live to see that.

NASCAR:

• It’ll take a while to get used to the new Ford Fusions.
• While I generally detest restrictor plate races, the changes to the aero-package made this a watchable race. Hopefully this will also hold true for next week’s Daytona 500.
• Kyle Bush remains top of my list for largest a**es in racing. I’ll grant that he is a modestly skilled driver, but he has nowhere near the talent he thinks he has, and he can’t pull off the moves he thinks he can. He only knocked out two other drivers yesterday, but then it was a short race.
• Jeff Burton has won the pole for next week’s Daytona 500. Burton is one of the most underappreciated drivers out there, and one of the most wellspoken. Watch: whenever the mainstream media needs to talk to a NASCAR driver it will inevitably be Jeff Burton or Dale Jarrett as they are only two who really know who to talk well.

Two common techniques used in PSA comics are the OMGIHTSTHTM and the ONISGS.

The OMGIHTSTHTM (better known as the Oh My God, I Had That Same Thing Happen To Me) occurs when a character reveals a previously unknown bit of personal history that just happens to fit the topic du jour perfectly. This personal history is rarely, if ever, mentioned again. A perfect example of this is Spider-Man’s previously unrevealed history of child molestation in the Spider-Man and Power Pack Special.

The ONISGS (also known as Oh No, I Suddenly Got Stupid) usually applies to sidekicks or teen heroes in PSA comics. Characters who previously have always been shown to be clever (or at least competent) suddenly lose all knowledge of a particular topic and have to learn about it all over again. Usually the hard way.

Today’s PSA ad is an example of an ONISGS. Robin, the most capable and intelligent of all the teen heroes, is revealed to know absolutely nothing about AIDS. Luckily he has a butler to show him the error of his ways.

No wonder he quit being Robin.

• Click on the image for a larger view.
• I like the way he leaves the Batcave — with one of the most advanced computer systems in the world — to “get some facts.” Where? Is he going to go rough up some viruses?
• Also, “HIV Virus” is redundant. The V in HIV already stands for “Virus”

Tags: comics medicine psa robin

To celebrate Valentine’s Day, here are the best pick up lines of the Legion of Super-Heroes:

Some of these are a little more risqué than normal for this site (but certainly nothing you wouldn’t see on network TV), so consider yourself forewarned if you’re of sensitive disposition.

Braniac 5: “Want to help test the integrity of my forcefield?” Cosmic Boy: “I can tell that you’re attracted to me.” Star Boy: “I am your density” Saturn Girl: “I like what you’re thinking.” Sensor Girl/Projectra: “Ever been with royalty?” Tellus: “I’m ribbed for your pleasure” Shadow Lass: “It’s better with the lights out.” Apparition:“I want to feel you in me.” Blokk: “Rock hard abs, baby.” Triad: “Triple your pleasure!” Polar Boy: “Please, won’t somebody go out with me?” Ultra Boy: “Maybe I can only do one thing at a time, but I do that one thing damned good.” XS:“OhmygoshIamsoexcitedIdidn’tthinkthatIwouldseeyouheretonightandyoulooksocutedoyouwantogooutsometimepleasesayyespleaseplease!” Dawnstar: “I’ve searched the universe for someone like you.” Element Lad: “You and I have a good chemistry.” Violet: (blush) “Giggle.” (blush) Colossal Boy: “Why yes, I am big in all the right places.” Sun Boy: “I’m on fire for you, baby.” Infectious Lass: “You make me feel all feverish.” Lightning Lad: “Can’t you see that there’s electricity between us?” Arm Fall Off Boy: “Damn.” Andromeda: “Anything you can do, I can do better”

UPDATE:
And how could I forget
Computo: “01010000 01101100 01100101 01100001 01110011 01100101 00100000 01101000 01100001 01110110 01100101 00100000 01110011 01100101 01111000 00100000 01110111 01101001 01110100 01101000 00100000 01101101 01100101″

Tags: comics legion of super-heroes valentines

This medical review of a rather blah House contains a few spoilers, so don’t say I didn’t warn you…

Adam, a 16 year-old boy, is riding an ATV when he loses control and it crashes, catching fire. He is severely burned and brought to the hospital for treatment. House’s team is consulted when the patient demonstrates tachycardia (an elevated heart rate) and low potassium despite standard burn therapy.

Due to a lack of skin on his chest, the team cannot run an electrocardiogram (also known as an EKG or ECG) to check heart rhythm, instead they have to use an old fashioned instrument, a galvanometer. The heart reading appears normal, but the patient suffers a seizure while they are administering the test.

The team is concerned that Adam may have a brain infection or multiple sclerosis. Because of his condition is unstable, they are unable to move him to radiology for a CT scan or MRI (though they seem to have no trouble moving him into a hyperbaric chamber, not to mention flipping him on his side later). Because of concern about infection, a lumbar puncture (also known as a spinal tap) cannot be performed either. The doctors ultimately perform “transcranial Doppler sonography,” in other words they are looking at the blood flow in the patient’s brain by ultrasound (though in real life this doesn’t work nearly as well as it does here). They see no evidence of infection or multiple sclerosis, but they do find a subarachnoid bleed.

Later, while Adam is in the hyperbaric chamber, the team notices that the patient is having an orgasm. There is thought that his brain might be misinterpreting sensations (i.e. feeling pain as pleasure), but there is still concern about infection or vasculitis. Cameron is concerned that the burns may be infected and this is overwhelming is brain, but somehow a single treatment with maggots proves that there is no infection.

House declares that they must perform a lumbar puncture, only they must do it in the neck where there are no burns. Of course, the neck is the cervical spine as opposed to the lumbar spine of the lower back, so this would be a cervical puncture instead of a lumbar puncture and any doctor — especially a neurologist like Foreman — would know this. Anyway, the spinal fluid shows no evidence of infection or multiple sclerosis.

House wakes Adam up, who despite being in tremendous pain (and one would suspect groggy and very confused) is able to tell House precisely that he felt no tingling in his legs before the accident, but did lose bladder control and pass out before the crash. House deduces that the patient had a seizure before the accident and decides that antidepressants must be causing Adam’s seizures.

Adam’s parents deny that their son was depressed, but House doesn’t believe them. He plans on waking up Adam again to ask about antidepressant use when he notices a cigarette burn on his wrist and nicotine stains on his fingers (so much for doing a thorough exam on admission). He realizes that Adam was using antidepressants to help him stop smoking and this caused his seizures (and other symptoms too, presumably).

Meanwhile, House’s nemesis from early in his training is giving a lecture at the hospital on his new treatment for migraine headaches. House injects himself with this doctor’s “miracle cure” and then induces a migraine in himself with nitroglycerin. He is pleased when the other doctor’ cure fails to work, but now he’s stuck with a migraine. In the end, the drug company pulls funding from this doctor after House e-mails them about the failure of the drug.

This was a very unimpressive episode of House, and frankly the worst in recent memory. It’s true that that the final solution was correct, but only to a point. Certain antidepressants do raise the risk of seizure. This is particularly true of bupropion (better known as Welbutrin or Zyban), the antidepressant prescribed to help people quit smoking. However, this has nothing to do with ordering shady drugs over the internet; it’s a known risk of a commonly prescribed drug. Also note that this is an entirely different class of antidepressants than those associated with serotonin syndrome (or “serotonin storm”, as they called it in the episode) — which is what Adam’s other symptoms were blamed on. And for the record, antidepressants are not the most common drugs used for smoking cessation; that would be nicotine, as in “nicotine replacement” (patches and gum), particularly because it can be obtained without a prescription.

Overall, the plot was cluttered and the complications contrived. Concepts were advanced that had little to do with the story (Ooo…maggots!), and stupid mistakes were made. The side plot, Dr. House getting revenge on an old rival, could have been fun but ended up being less exciting than the rest of the uninspired storyline (like a pharmaceutical company would stop studying a drug it spent millions of dollars to develop because it didn’t work a single patient? Get real!)

This episode gets a C for the mystery and another C for the solution. The medicine earns a D, because I’m feeling generous. The soap opera aspects earn a C-.

• Previous House reviews

Tags: television medicine house migraine seizure.

While indexing my comics recently, I ran across several enjoyable series that have apparently ended prematurely. I say “apparently” because they all ended mid-storyline and I have seen no offical word of their demise. Anyone know any more about these missing-in-action comics?

• Sylvia Faust
  Interesting and quirky. Solicited for four issues, yet only two were published. The official website lists no new information and seems to have been frozen in time after the release of issue #2.
• Elric: The Making of a Sorcerer
  This look at the early life of Elric was solicited as a four-issue mini-series, yet only two issues were released. This was published by DC with a big name artist (Walt Simonson) so I wonder what happened.
• Barbarossa and the Lost Corsairs
  Actually the entire Kandora line seems to have become lost. I assume the publisher folded up shop, but I’ve seen nothing posted about it. It’s a shame, because both Barbarrossa and Jade Fire were enjoyable.

And what about Forsaken? I remember a press release about the comic leaving Image but I’ve heard nothing since.

Tags: comics sylvia faust elric walter simonson kandora forsaken

Olga Pyleva, the Russian biathelete who won Silver in the 15km biathalon was disqualified and stripped of her medal today after her urine revealed traces of the banned drug carphedon.

Developed in the USSR, carphedon was developed to treat certain neurological conditions such as amnesia. There are claims that it also increases stamina and makes a person more resistant to the cold, though evidence for these effects are sketchy at best. Carphedon is banned by the IOC and other sports organizations just in case it actually works.

The defense of Pyleva mounted by the Russian team raises more questions than it answers.

As is usual in these cases, the athlete always denies any personal responsibility and blames their physician or trainer. In this case, the blame is being placed on her doctor. “This was 100 percent the physician’s mistake,” states Dr. Nikolai Durmanov, the head of the Russian Anti-Doping Agency. He defends Pyleva, saying that the doctor that treated her for a sprained ankle gave her an over-the-counter medicine that contained carphedon, yet it failed to list the substance in question as an ingredient.

I find this statement interesting because several months ago a similar allegation surfaced in professional cycling and one of their physicians stated that carphedon was not available in any drug on the market. According to that report, carphedon is only available in its pure form, and then only from certain web sites. It’s also interesting that a doctor is being blamed for presribing an over-the-counter drug, and a drug that was mislabeled at that. Did this doctor know this drug he supposedly prescibed contained carphedon or not? If so, what’s he doing treating Olympic athletes? If not, then it’s hardly his fault. That is if this “over-the-counter-drug-containing-carphedon-but-not-labeled-as-such” actually exists. (Yes, I know that doctors routinely suggest over-the-counter medications; I certainly do. But in this instance it smacks of a team frantically trying to set up several layers of deniability between their athlete and a positive drug test.)

Durmanov continues: “She used this product openly. She thought it was a vitamin. It’s an accident.” Again, an interesting statement. Durmanov is now saying saying that Pyleva was using the medicine — given to treat a sprained ankle — as a vitamin. While this doesn’t necessarily contradict what he said earlier, it doesn’t make a great deal of sense either.

In all fairness, Pyleva did pass two urine tests in January. However, given her team’s patchwork defense of her most recent test, color me very suspicious.

Links:

• The MSNBC News article about Olga Pyleva
• The Wikipedia entry on carphedon (updated today!)
• A Cyclingnews.com article about Danilo Hondo’s positive drug test

Tags: medicine news sports olga pyleva olympics carphedon

The GOOD and the BAD of the The Legend of Grimjack: Volume 4 trade paperback.

GOOD: The script by John Ostrander and the art by Timothy Truman. AndGrimjack. Grimjack is just cool.

BAD: The high IDW price point ($24.99). Sure, it’s a very nice high quality collection, but that’s still a steep price. I’m sure it all comes down to supply and demand: I’m willing to cough up that much for the Grimjack collections if it’s the only way I can get them, but how many readers are not picking up this series due to the cost?

GOOD: The original editors notes and references are left in place. It always bugs me when the footnotes and references are rewritten when a series is collected.

BAD: There is no easy way to tell which Grimjack issues are included. It would be nice if the cover of the collection listed what issues of the original series were collected, or at least listed them in the indicia like every other company seems to do. To figure out which comics are collected, you have to look at the cover gallery in the back and read the small print there (for the record, it collects issues #15-22, except for issue #21. There are also a couple of Munden’s Bar back-ups, but which issues those are from — or whether any were not collected — is not listed).

GOOD: Ostrander is at the top of his game here. All the various plots and threads from the first issue onward come together in a way that would make Chris Claremont turn green with envy.

BAD: That page in the middle of the truck fight was printed upside down, wasn’t it? It’s hard to tell because there’s some topsy-turviness to the art leading up to it, but the captions and everything are upside down, so I suspect it’s a goof. If it’s not a mistake and was done intentionally, it doesn’t translate well to the trade paperback format.

Tags: comics grimjack idw john ostrander timothy truman trade paperback

The secret to the operation that restored Jessica Drew’s Spider-Woman powers?

Breast implants, and large ones at that.

From New Avengers #14, script by Bendis, Art by Cho.

Tags: comics medicine avengers spider-woman bendis cho

A Monday episode of House brings us a young model and an interesting diagnosis. By the way, this medical review contains a few spoilers, so don’t say I didn’t warn you…

Alex, a 15 year old super-model, complains of feeling nauseous and is profusely sweating. Her father gives her a Valium and a drink of his champagne to calm her down. She heads on down the catwalk but stumbles. She experiences double vision and punches another model who tries to help. Finally, she collapses on the runway.

Alex is admitted to the hospital for evaluation of her collapse (though she describes it as more of a cataplectic attack). She admits to feeling sweaty and nauseous for a while. A history also reveals that she has yet to start menstruating. Lab tests are drawn and all are normal except for drug screen which comes back positive for “Valium” and “heroin.” The Valium can be explained by the pill her father gave her, but the heroin suggests to the team that she is suffering heroin withdrawal (I should point out that these tests are not that specific, so would have come up “benzodiazepine positive” and “opiate positive”, without identifying the specific drugs. For all we know, Alex could have been taking Xanax on her own in addition to the Valium her father gave her…)

The differential diagnosis includes heroin withdrawal, juvenile multiple sclerosis, and Parkinson’s syndrome. House suspects most of her symptoms are due to the withdrawal, but he wants her completely free from heroin so he can ensure that just the withdrawal was causing her problems. He decides to pursue a rapid detox. Basically, Alex is placed in a medically-induced coma and fed naltrexone. Naltrexone blocks the opioid receptors and sends the patient into a complete and immediate withdrawal. It is a risky procedure, but a real one and there are centers that specialize in it.

Alex suffers some sort of cardiac arrest during the coma. They refer to it several times as a “heart attack,” but it seemed more a rhythm problem than an actual heart attack (and if it was a heart attack, they did absolutely nothing to treat it or to prevent the next one). After she comes out of the coma, she has a problem with her short term memory, repeating the same questions over and over. The team is concerned that Alex may have suffered brain damage due to oxygen deprivation from her “heart attack.” House isn’t convinced. He feels she wasn’t without oxygen long enough to cause a problem; he suspects Post-Traumatic Stress Disorder (PTSD) because he thinks her father sexually abuses her. He orders an MRI and an LP (lumbar puncture) and he goes to have a chat with her father. The team tries to get an MRI, but Alex develops an uncontrollable muscle twitch so they can’t proceed with the test. They are able to perform a lumbar puncture which shows increased protein in her cerebrospinal fluid.

The doctors are now concerned about that Alex may have any one of a number of brain diseases including viral encephalitis, CMV (cytomegalovirus), and CJD (Creutzfeldt-Jakob Disease). House wants to proceed straight to a brain biopsy (instead of getting a CT scan, or sedating her for an MRI). The brain biopsy shows no white matter disease, so the team now starts to focus on the grey matter. Foreman lists off a whole string of rare neurological diseases and House suggests that it may be paraneoplastic syndrome. Paraneoplastic Syndrome is a rare disease that occurs when a person has cancer and their body attempts to make antibodies against the tumor. These antibodies misfire, and affect the person instead, causing a whole range or symptoms including weakness, memory loss, and problems with coordination.

Alex is given IV immunoglobulin and she stops twitching. This supports the diagnosis of paraneoplastic disease because the immune globulin is thought to block the antibodies causing the problems. She is now subjected to test after test trying to find the tumor House knows must be there. Small ovaries seen on a pelvic ultrasound, but every other test is normal.

House is still convinced there is cancer somewhere. The rest of the team are still thinking it may be PTSD since her father did admit that he had slept with her. House has a burst of insight and gets an MRI of Alex’s pelvic area. He discovers that Alex has “male pseudohermaphrodism” and has testes instead of ovaries. A tumor on one of these testes is what has given Alex her paraneoplastic syndrome and explains away all her symptoms. The tumor can be removed surgically, but what can be done for Alex who thought she was a she but may be a he (depending on how strictly you choose to define the terms). I think the psych consult was a good idea.

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The mystery was interesting and the final solution clever. I have only one major complaint about the final diagnosis (or rather, how they missed it), which I’ll get into a little later. The rest of the medicine was not perfect, but at least passable. Well, except for that “heart attack” thing.

The soap opera this week centered on two things: House’s increasing pain in his leg, and the sexual abuse of Alex by her father. As for House, is his pain physical in nature or psychological. He believes it is physical, but Wilson believes — and Cuddy proves — that it is to a large part psychological.

Alex father admits to having had sexual relations with Alex once. When House does not report this immediately to the authorities (which he is legally obligated to do in every state, even New Jersey), Cameron does. When both Alex and her father deny it every happened, there is nothing the social worker can do. Cameron confronts Alex, but Alex surprises her by telling Cameron that she seduced her own father, as well as every other male authority figure in her life, so she could get what she wanted. What is it with this show’s writers and overly manipulative women?

Back to the medical: Male pseudohermaphrodism is an older term that has fallen out of general use because it is a non-specific term, and can describe several different situations. The condition House is describing is Androgen Insensitivity Syndrome, also known as Testicular Feminization Syndrome. In this condition, a male fetus is resistant to the effects of testosterone. It develops testes but proceeds little further in male sexual development. The testes will not descend, and normal female external anatomy develops. The individual in question appears to be a completely normal female, though they tend to enter puberty later than other girls. They never develop a menstrual cycle as there are no ovaries or uterus. I can understand why Wilson may have thought Alex had ovaries on an ultrasound, because that’s what he was looking for, but he should have noticed the complete lack of a uterus. And even if they were testes, the ultrasound still should have picked up the tumor because ultrasound is what we use to find testicular tumors.

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This episode gets a B+ for the mystery and an A for the solution. The medicine earns a B, because I marked it down for the “heart attack” and the whole “whoops, I missed the uterus” thing. The soap opera aspects earn a strong B+.

• Last week’s House review
• A list of all previous House reviews

Tags: television medicine house super-model.

H, in the midst of all his Aqua-blogging, was kind enough to send the following comic book PSA ad my way:

From the year 1966 and Aquaman #27 comes “Health Myths Debunked!” — brought to you by the National Social Welfare Assembly (and of course The Comic Treadmill)

• This mysterious unnamed doctor gives sound advice. As an aside, I’ve always wondered where the idea of puuting a piece of beef over a black eye came from.
• Personally, I’m more puzzled by the unnamed doctor himself. Who is he, and what does he do — just hang around abandoned construction sites waiting for children to hurt themselves? That just isn’t right.
• I think the “Mysterious Unnamed Doctor” needs his own HeroClix.
• I like the totally random selection of health myths: puncture wounds, frostbite, black eyes, and shaving. They could have at least picked a theme and stuck with it (like “injuries incurred by playing on an abandoned construction site.”)

If you learn nothing else from the internet today, just remember what the Mysterious Unnamed Doctor™ says:

Tags: comics medicine psa

From the fine medical blog Fat Doctor, a perfect example of a patient who uses House as a source of medical information and diagonoses.

For those of you who ever wonder why I try to correct bad medicine when I come across it on TV and in comic books, this is one of the main reasons. People get their medical information wherever they can find it; the accuracy of the source is rarely — if ever — considered.

Don’t get me wrong, I thoroughly enjoy House (and before that, Chicago Hope and St. Elsewhere) and I’d never give up my comic books, I just wish they were more accurate on the medical front.

Tags: television medicine house.

I’d like to take another look at the Calculator, one of the chief villains in recent issues of Birds of Prey as well as Villains United. I last talked about him in my review of Birds of Prey #87 and whether he had Obsessive-Compulsive Personality Disorder (OCPD) or Obsessive-Compulsive Disorder (OCD). In the more recent Birds of Prey #90, some more information on his mental state comes to light and I think it’s safe to say that he has a lot more mental illness than he’s letting on.

What makes me think this?

1. He keeps insisting that the only thing wrong with him is Obsessive-Compulsive Personality Disorder. It seems to me that he’s trying too hard to convince someone that this is true.

   SIDE NOTE 1: The person he’s “talking to” in both issues is himself. So basically, he’s trying to convince himself that OCPD is all that’s wrong with him.

2. The medicines he mentions using in Birds of Prey #87, Serotonin Specific Uptake Inhibitors, aren’t good for treating OCPD (actually, nothing really is). They are some of the main medications used for depression and anxiety. They are also sometimes used in other conditions including OCS and Attention Deficit Disorder.

   SIDE NOTE 2: In Birds of Prey #87 he mentions that he’s having a hard time getting his medications because Lex keeps killing off his doctors. So I ask you, did he really stop the medications himself, or is that just his rationalization for not being able to obtain them anymore?

3. At the end of Birds of Prey #90 he is clearly hallucinating. This is not a component of OCPD and usually a sign of some more serious mental illness

So what is wrong with the Calculator?

It’s hard to tell since we’re only seeing part of the picture and since he’s not being honest about what’s going on — even with himself. I suspect writer Gail Simone has something up her sleeve and everything will be explained at some point. Still, allow me to go out on a limb and make my predictions:

First, I think he does have some OCPD. I think it’s one of the quirks that allows him to perfrom the job he does (and I suspect Oracle has some strong OCPD traits as well).

His main problem, I suspect, is schizoaffective disorder. This is a controversial diagnosis that not everyone agrees on it. Think of it as a combination of bi-polar disorder (manic depression) along with some schizophrenia thrown in for good measure. I think the Calculator has Manic-type Schizoaffective Disorder.

The Diagnostic Criteria for Schizoaffective Disorder are below the cut, or you might want to quit while you’re ahead.
Read more…

Scene from Friendly Neighborhood Spider-Man #3. Words by Straczynski, Pencils by Wieringo

While not as bad as the infamous operating room scene from Richard Dragon #10, there are quite a number of things wrong with this scene, both in terms of the writing and the art. I’ll happily admit that most are nit-picks, but there are a couple of glaring mistakes in there as well.

I’ve got eight items on my list, how many can you find?

However, before we start, let’s take a moment to recognize artist Mike Wieringo for being the first comic book penciler to correctly draw eye protection on all the surgical personnel, a key OSHA requirement.

• Previous Picture Quizzes

Tags: comics medicine spider-man operating room surgery straczynski wieringo

Scene from Friendly Neighborhood Spider-Man #3. Words by Straczynski, Pencils by Wieringo

Good job everyone! I think you got almost all the errors on my list, plus caught a few I missed.

Here’s the list I came up with:

1. Anatomy. The vena cava is a vein, not an artery (and it’s the “superior vena cava,” not the “upper vena cava”). A collpased lung is in the chest, not the abdomen.
2. Sterile Technique. Only the surgeon facing us is scrubbed in (he’s the only one in a full gown). At the very least, the OR Tech should be scrubbed in as she is handing him supposedly sterile equipment.
3. General Operating Room Technique. What’s with all the papers/cloths on the floor? Not are they liable to trip someone, the nurse carefully counts all equipment like that — several times during the operation — to make sure nothing is left inside the patient. There should be some sort of screen between the anesthesiologist (especially since he’s not sterile) and the patient. And what’s with all the blood? There should never be that much blood on the floor — or the patient for that manner.
4. Lines. Peter needs IV fluids, lots of them. Just a hint, if there’s enough blood to make a puddle on the floor, the patient probably needs a transfusion, or at the very least IV fluids. There should be a suction machine as well, to suck up all the blood, especially in the surgical field.
5. Airway. Peter should have been intubated. However, if he’s been so beaten up that he can’t be intubated in the normal manner, there is always nasal intubation or a trach. Anyway, if he’s that beaten up then there’s no way a mask would work.
6. Machines. What’s with all the machines? It’s like that scene in the beginning of Monty Python’s The Meaning of Life where they keep looking for the machine that goes “ping!” Also, if you’re going to have a light box for x-rays inside the OR (and most do), it would be a good idea to position it so that the surgeon can see it (and that is the most bizarre “rib” x-ray I have ever seen).
7. Emergency Care. Despite being injured, Peter was never placed on a back board or neck brace (I know it’s not in this scene, but I’m counting it anyway). Remember, the ABCs – Airway (mentioned earlier), Breathing (Hello? Collapsed lung? This should be what is fixed first), Circulation (after A and B are taken care of, then the surgeons can address all the rest of the bleeding). Peter’s in shock and ORs are cold — he should be covered up.
8. Lights. The lights are way too far back — they’re should be right over the patient. The shadows are bad — the surgeon’s shadow obstructs the surgical field and that would never happen in real life.

Tags: comics medicine spider-man operating room surgery straczynski wieringo

Birds of Prey #91“Donor”
Jim Alexander, writer (“guest” writer)
Brad Walker, penciler (“guest” penciler)
Hi-Fi Designs, colorist (Why am I mentioning the colorist for once? Keep on reading.)

The prognosis is acute renal collapse.

That’s really more of a diagnosis than a prognosis. Also, “Renal Collapse” is not a commonly used term. Renal Failure is the better one.

This doesn’t sound like an acute condition. The description makes it seem like his kidneys have been failing for quite some time, which makes it chronic renal failure instead of acute renal failure. Additionally, kidney transplants are used as a treatment for chronic renal failure and not acute renal failure.

Bull’s kidneys can no longer remove the toxins that accumulate naturally.

The kidneys serve several important functions in the body. One of them is filtering chemicals and toxins out of the blood. They also help regulate the concentration of electrolytes such as potassium and sodium in the blood. When the kidneys fail, toxins build up to dangerous levels and even electrolytes can rise to lethal levels.

A needle takes his poisoned blood into the machine. Another returns the filtered blood back into his system.

When the kidneys can no longer serve as filters, dialysis is started. Blood from the body is run through a special machine that acts as an artificial kidney, filtering the blood before it is returned to the body. It’s a complicated machine that requires close attention and specially trained personnel to operate.

The artist clearly did his homework in regards to the dialysis machine and draws an very accurate depiction of one. It’s shame that the colorist had to ruin it by coloring every single piece of tubing blood red. Even the one coming from the clear IV bag. Even the oxygen tubing.

However, while I give the artist credit for drawing a good dialysis machine, he has drawn way too many IV lines. Bull has five lines running into him, including two into the same site. Dialysis requires two: one to take the blood and one to return it. Like many other comic book artists, he also can’t draw a nasal canula correctly.

I ran this scene past a colleague of mine who worked in a dialysis center before going to medical school. He agrees with my thoughts, and he also points out the dangling IV tubing in the first panel. That’s never a good idea because the IV fluids don’t have enough pressure to work against gravity.

Last thought: Take a look at Huntress on the front cover. It’s another example of the De-Nudifying Effect (as described perfectly by Dave and Tom). Unless the Huntress’s flesh really is purple on her belly.

Tags: comics medicine birds of prey dialysis schizoaffective disorder renal failure

I’ve been reading The Maze Agency for years (since Comico, through Innovation and Caliber, and now IDW), and this recent issue is the only mystery I’ve managed to solve on my own.

Either I’m getting smarter or this mystery was pretty easy; I suspect the latter.

(Looking back, it was fairly simple and the bizarre first name of the one character made it a little too easy. Is that even a real first name?)

I used to doubt that people with any fashion sense at all would ever dress up in the bizarre costumes many super-heroes and villains see, to wear. ThenI watched the Olympics.

Several of the ski jumping ensembles would put the Trickster to shame, and whoever designed the Russian speed skating outfits should just do us all a favor and abandon a life in fashion.

Laura’s already shown the connection between Johnny Weir’s outfit and Aquaman’s costume, but what about U.S. ice dancer Tanith Belbin? That butterfly outfit is a little too close for comort to one of Rachel Summer’s Phoenix Outfits, and that other costume looks like those costumes-with-a-snake-on-it (which I can’t find any good pictures of at this point), or maybe Roulette and her snake tattoo.

Tags: comics tanith belbin

From a French AIDS campaign, here are the Man of Steel and the Amazing Amazon in bad shape. The implication apparently being that even the greatest of super-heroes can develop AIDS, so everyone should be careful.

These are from the same organization that put out the anti-AIDS ads featuring the scorpion and the spider last year. You know which ads I mean, right? If not, you owe it to yourself to click here (Probably NSFW).

I don’t speak French (other than a few choice profanities), so I’m not sure what the caption reads. Babel Fish translates it as “One is all concern with the AIDS.”

(I wonder what Time Warner and DC thought of their icons being used in such an ad campaign, even though it was for a worthwhile cause.)

Tags: comics medicine psa superman wonder woman aids france

This final part of the four-issue Hawk and Dove origin storyline starts where the previous issue left off. Hawk and Dove have followed Kestrel to the far off world of Druspa Tau. This world is the dimension their powers originate from and therefore their abilities are greatly increased here; both are near invulnerable and Dove can fly. There is also an ongoing war between the forces of Order and Chaos. Dawn helps the side of Order while Hawk finds himself the warlord of the Chaos army. After a brief battle, the Chaos forces succeed in destroying the Order citadel. At that moment, Unity — the combined form of the Lord of Order Terataya and the Lord of Chaos T’Charr — breaks through into the sky above and takes up the battle against the Lord of Chaos M’Shulla. T’Charr and Terataya are the entities who created Hawk and Dove and who grant them their power. Unfortunately, most of their own powers have gone into creating the pair, and they are quickly defeated by M’Shulla. Mortally wounded, they retreat to their lair.

Hawk and Dove go looking for Terataya and T’Charr but encounter the petulant Lord of Order Child and his monster companion Flaw. As usual, Child and Flaw provide little challenge as Dove quickly bests Child and Hawk shatters Flaw.

Next they encounter Kestrel, who has taken possession of Hank’s girlfriend Ren. Dove realizes that Kestrel is no more than a pale imitation of Hawk. Like Hawk, Kestrel’s powers come from a magical link to Chaos, but unlike Hawk who links to the entirety of Chaos, Kestrel is just linked to the violent portion. Using her newfound powers, Dove is able to separate Kestrel from Ren. Since Hawk’s link to Chaos already encompasses and overshadows Kestrel’s lesser link, Hawk is able to absorb Kestrel, destroying him.

Leaving Ren behind, Hawk and Dove reach the cave where Unity has hidden away to die. On their death bed, T’Charr and Terataya tell the pair that an eon ago the unthinkable happened: a Lord of Order and a Lord of Chaos fell in love. In order to prove to others that Chaos and Order can successfully work together, they created the spell that created Hawk and Dove, linking Hawk to Chaos and Dove to Order. However, with the death of Unity, the spell will end and Hawk and Dove will cease to be — unless Hank and Dawn absorb the dying essences of their respective Lords. Dove quickly absorbs Tertraya’s essence and Hawk, after some unsubtle coercion, absorbs T’Charr’s.

The dying Lords share a short conversation as their essence fades. There is a brief mention of “completing the experiment” and then a kiss. As they kiss, the Hawk and Dove of Druspa Tau revert to the Hawk and Dove of Earth, and then back to Hank and Dawn — still kissing. They break off the embrace and realize they are back in Dawn’s bedroom on Earth. As the issue ends, Hank and Dawn are left wondering what happens now that they’ve absorbed not only the powers of T’Charr and Tertaya, but also their feelings for each other.

Random Thoughts

• Don’t worry about Ren. Barter is provides her transportation back to Earth in exchange for her memories of Kestrel and the last of his essence.
• Have Child and Flaw every presented a challenge? Even back in Amethyst they were more laughable than threatening.
• It’s good origin story, particularly in the fact that it builds on the Silver Age origin instead of completely ignoring it. There are some flaws though. For example, it doesn’t explain why Don was originally chosen as Dove if the ultimate goal was for Hawk and Dove to have a child. It just doesn’t work that way. (The same argument can be made for the current Hawk and Dove team of Dawn and Holly Granger — that is if they’re still around after Infinite Crisis)
• Speaking of Infinite Crisis, how were T’Charr and Teratraya still alive to be killed in the Days of Vengeance Special since they died here?
• More Hawk & Dove, from the beginning

Tags: comics hawk dove kestrel .

Missing your weekly dose of medical education because House isn’t on tonight?

Don’t fret — just check out this week’s Grand Rounds over at A Chance to Cut is a Chance to Cure. Grand Rounds is the weekly collection of the best medical blogging on the ‘net. There’s always something fascinating to read and this week is no exception. Go check it out and be back for more House next week.