Polite Dissent

Another “just average” episode of House. I’ve come to expect more exciting and improbable medicine, and the show is just not delivering lately. To some extent, tonight’s episode was an ethics episode instead of a medical episode, and as such, it was still average.

Matty and Nick are brothers. Nick is fourteen and has leukemia. He has received total body irradiation to kill off his own bone marrow so that he can receive a transplant from his younger brother Matty, who is a perfect match. On the day of the procedure, Matty is found to be sick: he is sneezing and has a fever and an enlarged spleen. House’s team has only a few days to find out what is causing Matty’s infection and get him cured so that he can donate his blood marrow before his brother dies.

The team decides to make him sicker so that it will be easier to find the cause of the infection. They expose Matty to cold, wet condition and they also remove his white cells (the infection-fighting cells of the blood) through leukophoresis. Matty is getting sicker, but no clear causative agent has emerged. In addition to a snotty nose, Matty complains of a sore right shoulder and a swollen testicle. House suspects Matty’s acute scrotum is infectious and has the team runs tests for E. coli, tuberculosis, Brucella, Klebsiella, and entero- and adenoviruses. The tests all turn up negative (which really is no surprise as an acute scrotum in a ten year-old is unlikely to be infectious). Looking over other test results, Chase notes a high CKMB (an enzyme that is often elevated with heart damage or injury). A transesophageal echocardiogram is obtained and shows a thickened mitral valve. The team believes that Matty has bacterial endocarditis and that this is the source of the infection. The normal treatment for endocarditis is several weeks of antibiotics, but House decides to rush things. He wants Matty’s mitral valve to be surgical removed and replaced to eliminate the source of infection. He believes that this will allow Matty’s bone marrow to be ready in time to donate to Nick. Of course, Matty will probably end up on blood thinners for the rest of his life (depends on whether they would use a mechanical valve or a porcine valve).

As the surgery is being performed, Wilson discovers that the mitral valve growth is fibrous and not infectious and the surgery is called off. The team now suspects that Matty’s condition may not be infectious, but instead an autoimmune disease such as Lupus or Behçets Disease. Tests show no evidence of autoimmune disease.

Meanwhile Nick has started to bruise, suggesting that he needs the bone marrow transplant fast. Foreman suggests pressing ahead with a partial match donor, but House and Wilson believe that there is too much of a risk of graft versus host disease.

Matty is now bleeding from his ears and his blood counts are dropping. Whatever infection he has is suppressing his bone marrow — or it could be the medicine he’s on that’s suppressing the marrow.

The partial match bone marrow transplant is carried out, but Nick has developed high grade graft versus host disease and the medication is not controlling it. His prognosis is very poor.

The team stops Matty’s medication, but there was no bone marrow recovery, so it is unlikely to be the medication’s fault (though they only waited a few hours and it can take days for medications to clear the body, particularly in ill patients). Blood cultures are negative. Knowing that Nick’s condition is fatal and he is immune suppressed, House wants to expose him to Matty’s infection so they can get a better chance to identify it. The parents refuse. Wilson and Foreman continue to run tests on Matty, hoping to find the cause of the elusive infection. In the meantime, House talks to Nick and convinces him to save his brother’s life. Nick agrees to play incubator to Matty’s germs. Luckily, at the last moment, Wilson and Foreman have discovered that Matty has contracted histoplasmosis, a fungal infection he developed because his house was built on farmland and he was exposed to soil from an old chicken coop. Matty should be cured with a course of Amphotericin B. The parents ask if he’ll be better in time to donate bone marrow to Nick. Cuddy sadly tells them no, that the infection has weakened Matty’s bone marrow too much. This doesn’t stop Foreman: he straps Matty down and performs a painful bone marrow collection procedure (which seems to contradict what Cuddy just said). It all ends happily, with both brothers recovering and living happily ever after (one presumes).

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The medicine was mediocre, and I expect better from House. The mystery was good and the solution logical, but there seemed to be a great deal of forgotten symptoms (and/or red herrings) this episode: shoulder pain, the increased CKMB, and acute scrotum for starters. At the very least, the team needed to ultrasound his testicle to rule out testicular torsion, a devastating condition. Histoplasmosis generally causes only mild disease in immunocompetent patients; diffuse disease occurs in immunocompromised patients (such as AIDS patients). Of course, Matty’s white cells were removed so that did compromise his immune system — but fungi are slow growing so it would take at least several days to see any response (and similarly it would take at least several days of Amphotericin to treat the infection, not one dose then slap him down and take his bone marrow). Taking his white cells may have seemed a good idea in theory, but really wasn’t a good idea in practice. For one thing, white cells are responsible for many of the signs of infection we look for such as fever. The contradiction between what Cuddy told the parents and what Foreman did right after didn’t help the storyline either. And I hope I don’t need to mention that Foreman’s actions were entirely unethical. He needs informed consent, and a ten year-old is way too young to truly understand the risks and benefits of the procedure. What Foreman did was no better than assault and child abuse. So as not to end on a downer, the show’s portrayal of Nick’s acute graft versus host disease was well done.

There were a bunch of stupid lines that stood out badly in this episode. First was House’s contention that narrow spectrum antibiotics work faster than broad spectrum ones. The spectrum of the antibiotic has nothing to do with its speed, they’re unrelated. Then there was Cameron’s claim that Matty’s blood was “literally turning into water.” Even if there aren’t many blood cells left, there are still plenty of other proteins, enzymes, and chemicals in blood to make it a lot more than water — I sure wouldn’t drink it. Finally, there was Foreman’s statement that Matty was too sick for sedation. That’s simply ridiculous. Collecting bone marrow without analgesia is a hell of a lot harder on the body than anesthesia — or at the very least pain medicine — would be.

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I give the medical mystery and the solution both a B. Like last week, the medicine was haphazard and and just average, which is why it earns a weak C. The House/Wilson/Hector soap opera was good, but the Foreman scenes were too heavy-handed for my taste. I give this aspect of the show a B as well as an N (Needs more Cuddy).

The previous House review
A list of all prior House reviews

Tags: television medicine house leukemia bone marrow transplant histoplasmosis

With 52 coming to a mostly satisfying conclusion this week, I thought I’d take a look back at some successful and not-so-successful endings of other series. This is by no means an exhaustive list, just the ones that quickly popped into my head. Feel free to add to it, or disagree with my opinions:

I think the comics that have had the best endings are those where the author had the conclusion planned from the very beginning, or at least several years beforehand. This would include Preacher, Transmetropolitan, Starman, and Sandman. I think that Starman had the best ending, but that’s mostly because it struck the sentimental chord in me. Transmetropolitan had a great conclusion for both the storyline and the characters. Preacher ended pretty much the only way it could. Sandman wasn’t quite as successful an ending because I don’t think the final issue coda added much, but your mileage may vary. (Lucifer would also fall into this category, but I didn’t find the ending as satisfying as the other books mentioned).

“Whatever Happened to the Man of Tomorrow” was a very satisfying end of the pre-reboot Superman books, but then I’ve always been a fan of alternate histories.

Hawk & Dove managed to tie up its loose ends in its final issue, but you could tell it was rushed. The multiple artists necessary to finish it also hurt the feel of the book.

JLA and JSA both started out great and had some phenomenal storylines, but both limped across the finish line. The ending of the previous Checkmate series also left me unimpressed.

When I think of disastrous endings, the mid-major storyline abrupt endings of the Crossgen series were nothing short of a debacle. Many canceled comics end mid-storyline, but the whole company’s comics all ending in the midst of a major “world defining” crossover? Horrible, no matter how you look at it.

JSA Classified #24 “Nightfall, part 2”
J.T. Krul, writer
Alex Sanchez, penciler

In the previous issue, Dr. Mid-Nite fought the self-professed vampire Mircea and lost. As this issue begins, Mid-Nite retreats to his sanctum and considers the situation. He is positive that Mircea is not a real vampire. Instead, he is certain that there is a scientific explanation for Mircea’s appearance and abilities. He considers conditions such as Congenital Insensitivity to Pain (a genetic disease where the patient cannot feel pain, heat or cold. It was feature in a recent episode of House)and Familial Dysautonomia (an inherited condition marked by poor development of the autonomic nervous system as well as some sensory nerves), and severe anemia. Ultimately, he decides that the diagnosis that fits best is Xeroderma Pigmentosa

Xeroderma Pigmentosa (XP) is an inherited condition¹ where the skin is extremely sensitive to light. A person with XP suffers from many skin problems including a thin dry skin that ages prematurely. Their eyes are extremely sensitive to light and easily become bloodshot and irritated. An individual with XP lacks the normal mechanisms that repair DNA damage caused by UV radiation. Because of this, they develop frequent skin cancers.

Dr. Mid-Nite realizes that not only does Mircea suffer from XP, but he has been taking high doses of Steroid A39 to control the disease. It is the steroid that has been giving him the increased strength, as well as the pallid skin and eyes associated with vampires. Armed with this knowledge, Mid-Nite once again confronts Mircea and is able to use his own strength against him. While Mircea is down, Mid-Nite injects him with Rocuronium³, a paralyzing agent, and has him hauled off to an insane asylum.

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Notes:
¹Xeroderma Pigmentosa has an autosomal recessive inheritance pattern.

²This answers a question I had from the Dr. Mid-Nite mini-series. That story mentioned a condition called “Xenoderma Pigmentosa.” I was never certain if that was a typo for Xeroderma Pigmentosa, or if the writer (Matt Wagner) was inventing a new disease. Apparently it was a typo.

³Rocuronium is a good paralytic agent. It would paralyze Mircea’s skeletal muscles rendering him helpless. Unfortunately, there is a good chance it will also paralyze his diaphragm — an important breathing muscle — and he will suffocate if he doesn’t receive mechanical ventilation until the drug wears off (and its half-life is between 1 and 2 hours).

Tags: comics medicine dr mid-nite vampire xeroderma pigmentosa rocuronium

A psychic nosebleed two-fer this time. In a previous post, we saw Nate Grey’s nose start to bleed when he got too near to Cable, since apparently meeting your alternate dimensional self causes a nosebleed — or at least it does if your both psychic. In X-Man #14, Nate Grey and Cable join up to fight Exodus (talk about your consummate ’90s villains — Marvel should have just let him remain forgotten instead of bringing him back post-House of M). Because they are in such close proximity to each other, both Nate and Cable end up with a bit of a nosebleed (and an ear bleed too, in Nate’s case). Have you noticed how Nate always seems to get the worse of it whenever he encounters Cable? Remember he’s supposed to be the more powerful mutant. I guess that’s a corollary to the rule about meeting your alternate dimensional psychic self: whoever is the stronger telepath will bleed more. You’d better get a pen and write that down — you never know when it might come in handy. All previous Psychic Nosebleed Zen posts Tags: comics medicine nosebleed nate grey cable

Scene from Thunderbolts #113. Words by Ellis, art by Deodato

Look at that — it seems that my prediction was correct. Norman Osborne does indeed have Bipolar Disorder.

Of course, I didn’t predict Moonstone messing around with his medication, but I did call her one of the worst doctors in comics — so let’s just say that I’m batting .667.

Tags: comics medicine thunderbolts warren ellis bipolar disorder

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This coming Saturday marks the 187th birthday of Florence Nightingale. Known as “The Lady With the Lamp,” Nightingale was one of the founders of modern nursing. To celebrate her birthday, I dug out this comic book PSA about her from Ben Casey #3 (Dell, 1962).

Tags: comics psa nurse florence nightingale ben casey

It’s the most shocking House yet! Not really — I just thought I’d mimic the ads that play every week (at least on the St Louis affiliate). How can every week be the most shocking?

In reality it was just another so-so episode. The mystery was good, but House’s final deductive leap was a little too unbelievable. The medicine was just OK, but the soap opera parts were much better than the past few weeks.

Addie, a nineteen year old college sophomore is sparring in a karate match when she suddenly begins spitting up blood. In the ER, a bronchoscopy was performed (looking down her lungs with a fiber optic scope). An Upper and Lower GI were also performed, as well as multiple blood tests. All were normal.

Chase suggests that Addie might have a hyperdynamic heart — one that’s pushing more blood than it should, causing extra blood to leak into the lungs causing a bloody cough (this is quite a stretch). A stress echocardiogram is performed but is normal. Chase notices that Addie has goosebumps, yet denies feeling cold or scared. Foreman states it might be a hypothalamic injury while House believes it is a sign of infection. He orders blood cultures, a lung biopsy, and starts her on antibiotics. She later develops diarrhea, but this is blamed on the antibiotics and never mentioned again.

Addie suffers respiratory arrest and requires intubation. She has a pleural effusion (a fluid build-up around the lungs) which is drained by thoracentesis. The effusion is transudative (this has to do with how much protein is in the fluid) which usually represents liver failure or heart failure. These seem unlikely since her echocardiogram and liver function tests were normal (though kidney failure can also cause a transudate — just foreshadowing here). House spots a trace amount of blood in the fluid and believes that it confirms his infection hypothesis, while Cameron points out that blood in the fluid could also represent a cancer. House next orders an arteriogram which is also normal. He is now convinced that the patient has Complement H Deficiency, a deficiency he claims is so rare that there’s no way to test for it. And it’s untreatable and fatal. A macular biopsy is performed but is negative (the macula is the most sensitive part of the retina; there seems to be a connection between age-related macular degeneration and certain types of Complement H abnormalities.). This doesn’t confirm House’s diagnosis, but it doesn’t disprove it either, so he considers it a good sign. The rest of the team point out that her symptoms could be caused by a brain clot or tumor. Cameron states that Addie was bleeding, so she can’t have a clotting disorder (Cameron’s never heard of DIC, apparently), so it must be a tumor. House still maintains Addie’s symptoms are due to the Complement H Deficiency and infection. An MRI is obtained, but shows no clots, tumors, or signs of infection. While in the MRI tube, Addie complains of a severe headache. The team pulls her out and discovers that a chunk of her scalp has become necrotic and started to bleed out. House believes this fits with his infection theory, but Chase states that it could be an autoimmune disease. He wants to put her on steroids. House states that if Chase is wrong and House is right, then Addie will likely have a heart attack as soon as the steroids are started and die. He allows Chase can give the steroids, but only with Cameron standing by with defibrillator paddles. The steroids are given and no heart attack results.

Later that night, House is woken by the news that Addie has developed severe kidney failure due to Hemolytic Uremic Syndrome (HUS) and is on dialysis. House points out that HUS is often caused by an infection (and is more common in people with certain Complement H deficiencies), then trots out the false dichotomy of the episode: he states that since Chase was wrong, House must be right and therefore Addie must have Complement H Deficiency. This means that she will soon die of her disease. She slips into ventricular fibrillation, but Foreman is able to revive her. House takes this as the final sign that he’s right and goes to talk to Addie and her parents. Shortly after talking with them he has a conversation with Wilson, and it the middle of it realizes that Addie does not have Complement H deficiency. Instead, Addie is depressed and has a death wish. She tried to kill herself with drain cleaner, but instead of drinking it, she placed it in a gel cap and swallowed it. This way, it didn’t start to dissolve her GI tract until it hit her intestine where it ate a hole (leading to spitting up blood). Scar tissue covered the hole, so the bleeding stopped, but the damage caused an artery and vein to grow together and this mixing of venous and arterial blood is seeding infections throughout her body. By repairing the blood vessel, Addie will be able to recover physically, but still has a ways to go mentally.

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Not that the House writers have ever made it a completely fair mystery, but this week they definitely weren’t playing fair with the clues. Each episode usually makes a big deal of searching the patient’s house, but it wasn’t shown at all this week (though Cameron was ordered to) — and it would have likely turned up some positives (empty gel caps and drain cleaner, for instance). A patient has a likely gastrointestinal bleed, yet no EGD or colonoscopy were performed — because one of them should have showed the healing bleed, or at least the scar tissue (and according to the links in the narrative, the GI series should have shown scar tissue as well). Addie has all these infections, yet her blood cultures are all negative?

Otherwise, I’m not clear on the use of the arteriogram to look for infection, nor am I entirely certain why her “head exploded.” And why would steroids suddenly cause a heart attack? From what I’ve been able to ascertain, it is possible to test for Complement H deficiency (molecularly, functionally, and genetically). It may not be a common test, but since when has that stopped House?

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I give the medical mystery a B+, because it was intriguing. The final solution I give a C. It was clever, but the way House was able to deduce exactly what happened, down to the anatomic level, instantly and without any lead up I found too unbelievable, even for House. Yet again, the medicine was blah. Not completely horrible, but not particularly good either. This is Grey’s Anatomy level medicine — it may be fine for that show, but it earns a weak C here. The soap opera was quite enjoyable this episode, particularly the whole Wilson on speed scene. I give it an A
The previous House review
A list of all prior House reviews

Tags: television medicine house complement h hemolytic uremic syndrome suicide

It’s a statement that crops up frequently: humans only use 10% of their brain. I’ve seen it on ads, television shows, movies, books, and comic books — just to name a few. It’s an intriguing idea, but one that is utterly wrong.

There’s some debate where the idea that we “only use 10% of our brain” originated. Some blame it on misunderstood statements from physicist Albert Einstein or anthropologist Margaret Mead. Popular psychologists in the early twentieth century seem to have popularized the idea as well. For instance, famed psychologist William James stated in 1908 that “We are making use of only a small part of our possible mental and physical resources.” Karl Lashley performed experiments on rats in the 1930s that seemed to confirm this idea at the most basic level.

More recently, the statement has been ingrained in popular culture thanks to its repeated use by advertisers. It’s also become a favorite of quacks and charlatans. Take a look around the web or at the “new age” section of the bookstore and see how may “psychics” or paranormal “experts” repeat this 10% claim. Why look, here’s a quote from (in)famous spoon bender Uri Geller: “In fact, most of us use only about 10 percent of our brains, if that.”

Regardless of the source of the statement, it’s all bunk. The idea that humans only use 10% of their brain is completely wrong; we use much more of our brain than that. There are several ways to prove this. There is a clinical answer as well as an evolutionary/developmental approach. To me, the simplest answer relies on modern technology such as PET scans and functional MRI (fMRI) to look at the brain. These studies measure blood flow, which shows which parts of the brain are in use. Thus we can see for ourselves how much of the brain is used. The answer is that even during quiet moments, much more than 10% is active. In fact, over the course of a day, nearly the entire brain is in use at one time or another. The last time I checked, that was a lot more than 10%.

Here’s a much more in-depth article on the 10% Myth from the Skeptical Inquirer
A nice YouTube video where James Randi exposes Uri Geller.

Tags: comics medicine hulk brain psychic

Take a look at the first couple of paragraphs from the Associated Press article “Bacterial Outbreak Sickens Missouri Tots” and tell me what the mistake is:

Youngsters in the St. Louis area have been hit hard in the last six months by an outbreak of shigellosis, an infectious disease that isn’t typically life-threatening but can cause severe flu-like symptoms.

Since Nov. 1, 648 people statewide _ primarily kids ages 4 and younger and their caregivers _ have come down with shigellosis, and most of the children attend day care centers. All but about 100 were in the region that includes St. Louis and surrounding counties, said Larry Phelan, an epidemiologist for the Missouri Department of Health and Senior Services.

The disease is typically characterized by diarrhea, headaches, nausea, vomiting, stomach aches and cramps.

Link to the full article at seattlepi.com
Other quizzes

Hi everyone. This is Scott’s wife and I am posting on his behalf. For the next few days Polite Dissent will not be updated. Scott is in the hospital after having a minor myocardial infarction (heart attack). He is doing fine now and I’m sure he will give you all the details when he can.

Greetings everyone! I’m very happy to be back home from the hospital.

First off, I’d like to say thanks for all of the get well comments, e-mails, and thoughts. My wife and I truly appreciate them.

As for me, it looks like little permanent damage was done (except to my ego, which took a pretty solid hit). The cardiologist says that I can be back to full activity, including jogging and biking, in a month. In the meantime, I’ll just have to relax and catch up on reading, television, and a few other projects that have been stacking up.

Once again, thanks for all the kind thoughts and it’s good to be back!

A better episode this week than the last few, though there were still some strange holes in the medicine. The soap opera wasn’t as good as the last few weeks though.

Nate, a brilliant but unpleasant teenager is competing in a speed chess tournament. He wins his game easily, but becomes suddenly violent after the match and starts pounding his opponent with the time clock until he’s unconscious. Nate then complains of a terrible headache.

Once admitted to the hospital, Nate is evaluated by Chase who brings his case to the rest of the team The initial differential diagnosis includes parasites (tests are negative), brain tumor (MRI is negative), toxins or drugs (tox screen is negative). Foreman suggests an adrenal gland tumor, but House suspects Nate is suffering from cluster headaches. House wants to start Nate on blood thinners and transcranial magnetic stimulation (there’s a lot of other treatments they should have tried first). Neither treatment works, and Nate continues to complain of his headache, as well as face, shoulder, and stomach pain — but these last ones are attributed to the multiple fights he’s been in recently (but what do stomach pains have to do with fights?).

House persists in his belief that Nate has cluster headaches. Cameron suggests hemochromatosis (an iron storage disease) but House points out that it wouldn’t explain the personality changes. Chase suggests hypothyroidism but House shoots the idea down explaining that Nate does not show any of the metabolic slowing seen with low thyroid levels. A ruptured dermoid cyst is mentioned as well, but no sign of it has shown up on any scans. House decides the best treatment is to give Nate psychedelic mushrooms because the psilocybin in them is thought to help with cluster headaches (i’d be interested in how House got his hands on a Schedule I Controlled Substance). The mushrooms do seem to help his headache, but also make him very horny. He flashes his equipment at Cameron — she is underwhelmed and in fact notes that he has hypogonadism (abnormally small underperforming testicles). Concerns now include a hypothalamic lesion or a craniopharyngioma. House wants a biopsy of Nate’s pituitary gland. While he is refusing the test, he becomes dizzy and passes out. Examining Nate, Chase notes that he is showing signs of jaundice — a sign of liver failure.

The differential diagnosis of liver failure is a long list. Diseases mentioned include Wilson’s disease (a disease of copper metabolism, but his copper enzymes are fine), cancer, primary sclerosing cholangitis (an inflammatory disease of the bile ducts), alcohol abuse and Ornithine transcarbamylase (OTC) deficiency – a genetic condition where the person has trouble eliminating excess nitrogen from the body). House orders a “hamburger test” (a large meal of meat because proteins contain lots of nitrogen), but the results are negative. He next orders the Young Guns to withhold all food from Nate to rule out Diabetic Steatosis (abnormal fat accumulation in the liver caused by diabetes). Nate becomes violent and when asked to produce a urine sample and pees on the floor. It turns out that he has quite a bit of hematuria (blood in the urine) that in case shows that Nate has also developed kidney failure.

The differential now includes HIV, hepatic fibrosis, MCADD (Medium Chain Acyl-CoA Dehydrogenase Deficiency — another genetic metabolic disease. Patients with this one get very sick if they skip meals), and Von Gierke Disease (also known as Type I Glycogen Storage Disease). The tests for all these conditions are all negative, but Chase does discover that Nate has a partial HPRT (Hypoxanthine-guanine phosphoribosyltransferase) enzyme deficiency that means he may have Kelley-Seegmiller Disease (better known as Lesch-Nyhan Syndrome). House decides to test Nate by purposefully getting him angry. He plays him in a game of chess while taunting him. In the end, House appears to lose the game, but Nate has a seizure. The team discusses possible diagnoses and House now fixates on Foreman’s suggestion of Amyloidosis. He starts Nate on immunosuppressants and starts looking for a bone marrow donor. In the meantime, Foreman performs a nerve biopsy looking for the signs of the amyloidosis, but the test is negative. House is unconvinced and sends Foreman back to do another biopsy. Meanwhile, a discussion with Chase turns House on to the actual diagnosis –- hemochromatosis. The bad personality has nothing to do with disease; Nate is just a jerk. The “eureka moment” came when House realized that Nate is unable to bend his thumb so he holds his chess pieces unusually. This is due to the iron deposition from hemochromatosis affecting his joint mobility. It’s a good news/bad news scenario: Nate should be able to control his hemochromatosis with treatment, but he’ll always be a jerk.

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I thought the medicine was better this week than the last few weeks, but still not as good as it’s been in the past. There was a great deal of jumping from one diagnosis to another without good flow. The whole “cluster headache” idea was handled poorly. His symptoms did not fit the condition. Steroids are not the main treatment of cluster headaches, and not everyone with cluster headaches have puffy eyes. There are many more treatments they should have tried, especially triptans and oxygen. The amyloidosis seemed like quite a stretch. Simple blood tests should easily show hemochromatosis, and I’d also suggest a liver biopsy , which is generally a good idea when there is liver failure with an unknown cause. At the very least, a liver ultrasound or CT scan should tell quite a bit, like whether there’s a fatty liver or not. I liked how the diagnosis rested on a symptom shown in the very first scene, but I’m puzzled shy why no work up was ever made of all the aches and pain he had.

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I give the medical mystery a B, because it was fairly interesting (though I laugh at House telling Cameron that there is always a single solution). The final solution I give an A. It was clever and actually telegraphed for one. The medicine earns a B-. Better than it has been, but it still should be better. Hemochromatosis should have been found much quicker, and they need to go back to school to learns more about cluster headaches. The soap opera was fair and earns a B.

The previous House review
A list of all prior House reviews

Click on the image for the full ad.

First up, from Kamandi #12 (December 1973), is the “Big Break” we’ve been waiting for all our lives! At least that’s what the ad says, so it must be true. Personally, I suspect that Jim is a drug dealer or spammer and just made up the whole electronics school as a scam, much like those “work from home” websites (send me money and I’ll tell you how!)

Finally, from Superman’s Pal Jimmy Olsen #83 (March 1965), comes an ad for Silly Putty. Remember, if your comic book shop doesn’t carry Silly Putty, it must not be a good shop!

Tags: comics advertisement kamandi jimmy olsen electronics silly putty

New Avengers #28 “Revolution, part 2”
Brian Michael Bendis, writer
Leinil Yu, penciler

This is yet another example of the word homeopathic being used as a buzzword in a situation where it makes no sense.

Homeopathy was developed in the 19th century as an alternative to the conventional medical care of the time. Of course, given that 19th century medicine consisted of such wonderful concepts as bloodletting, cupping, and trepanation, it’s understandable that a less aggressive manner of treatment was developed. Since the 19th century, conventional medicine has progressed by leaps and bounds — homeopathy has stayed the same.

Homeopathy follows two “principles”: The Principle of Similarities, and the Principle of the Infintesimals. Let’s say that we had a patient with hives. The Principle of Similarities states that to treat a symptom, you need a substance that causes the same symptoms. For the purpose of our example, to treat hives, we would need to use a substance that actually caused hives. A solution would be made from this substance and then diluted down (the Principle of Infintesimals) to such an incredible extent that it is unlikely that even one molecule of the original substance would remain in the solution. This ultra-dilute solution (in reality: water) would be used to treat the hives.

Medically, Homeopathy is nonsense and bunk. Logically, it makes no sense, and multiple rigorous scientific studies have confirmed that it works no better than placebo. I’ll grant you that there are no side effects — but that’s just because the treatment is simply water. But let’s assume for a minute that Homeopathy does work — and even then Dr. Strange’s statements make no sense. Is he casting a spell that actually worsens her vital signs, but “diluting” the magic? Casting a placebo spell?

I’d suggest he become less chatty and simply cast some real magic, or at the very least use some of his medical skills to stabilize her vitals.

Tags: comics medicine homeopathy avengers dr strange brian bendis

We’re all well familiar with the fact that psychic powers can cause nosebleeds. But what else can lead to nosebleeds in comic books? Here are three of the top causes of comic book epistaxis:

Sonic Blasts	Drugs
Conan

Scenes from Stormwatch P.H.D. #6 (Gage, Mahnke), Iron Man: Hypervelocity #3 (Warren, Denham), and Conan #38 (Truman, Nord).

Tags: comics medicine nosebleed stormwatch iron man conan

Lloyd Alexander died on May 17th. Growing up, he was my preferred sword and sorcery writer with his Prydain Chronicles (The Book of Three, The Black Cauldron, The Castle of Llyr, Taran Wanderer, and The High King). If you haven’t read his books, start with The Book of Three and go from there. Try to find the editions from the 1990s with the wonderful Jody Lee covers.

New Excalibur #19 “The Game Begins!”
Chris Claremont, writer
Scot Eaton, penciler

It’s been a month since she collapsed. Her heart skipped a beat, a bunch of cells packed it in and then got swept along her bloodstream up to her brain – where they formed a blockage. As a consequence, part of her brain died.

Three months in, and it’s still not clear what kind of stroke TJ suffered back in Excalibur #16. Broadly speaking, there are two types of strokes: the more common ischemic stroke, where a clot blocks off the blood flow to part of the brain; and the less common hemorrhagic stroke, where there is a bleed into the brain.

Initially TJ’s symptoms seemed more suggestive of a hemorrhagic stroke, and in fact that is how Sage described her stroke in Excalibur #17. This issue though (after not being mentioned at all in Excalibur #18), the narration clearly describes an ischemic stroke.

I’m a little unclear on the concept of the heart “skipping a beat” causing a stroke. Everybody’s heart skips a beat or throws in an extra beat a couple of times a day (more often if you like caffeine, stress, or decongestants). There’s nothing particularly dangerous about occasional skipped or extra beats. When the abnormal beats becomes more frequent and occur in long stretches, then you have a problem (but a heart problem, not a stroke problem).

Admittedly, certain abnormal heart rhythms — such as atrial fibrillation — can make a person more susceptible to an ischemic stroke, but one hopes that her doctors would be able to find out quickly if TJ has a-fib (hint: listen to the heart or check the pulse). There are anatomical abnormalities that can make ischemic or hemorrhagic strokes more likely. Given TJ’s generally “unusual” appearance, this would probably be a good area to explore.

Tags: comics medicine excalibur chris claremont stroke atrial fibrillation

Given recent events, I thought it was a good time to take a look at another American Heart Association PSA, this one celebrating its volunteers. Click on the image to the right for the full ad. The American Heart Association has a long history of comic book PSAs, from small single-frame ads hidden among the advertisements to larger full page ads. They’re always black and white, but usually quite eye-catching and memorable. Other notable American Heart Association PSAs include: The Big Heart Commissioner Gordon’s Heart Attack Tags: comics medicine psa heart american heart association

I’ve spent wasted the day playing Final Fantasy XII and reading Melanie Rawn’s new book Spellbinder.

Nightwing Annual #2 “Hero’s Journey”
Mark Andreyko, writer
Joe Bennet, penciler

Just like Renee Montoya, Nightwing has gotten himself a magic cast. In the first panel (when he’s leaving to join Bruce and Tim on the boat), it’s a modified short-arm cast covering the elbow, while in the second panel (when he’s on the boat with Bruce and Tim) it’s a standard short-arm cast, ending before the elbow. And I’m not bothering to show the panels where he seems to wearing the cast over his costume because I simply cannot explain those.

Actually, I’m not sure why he needs a short-arm cast at all. He injured his right arm while trying to twist out of the way of some spikes while falling. He landed wrong and took the brunt of his fall on the right upper arm, possibly the shoulder and elbow as well. If an injury in that area is going to require a cast, it’s going to need a long-arm cast, not a short-arm cast. The sling makes sense though.

Cast comparison

Tags: comics medicine nightwing cast

SHIELD Scientist: We’re after the Homo habilis. We want the caveman.

SHIELD Scientist: The pre-man, regardless of his origin, is an evolutionary time capsule. He is from a time before cancer, before AIDS.

Homo habilis lived during the early Pleistocene, roughly 1.8 – 2.5 million years ago. It is entirely likely that they lived before AIDS (though there were probably equally nasty diseases back then). It is untrue to say that Homo habilis lived “before cancer”; they did not. The first documented evidence of cancer dates back to 300-350 million years ago, the time of the vertebrate fishes — long before the first dinosaurs appeared, let alone ancient man. The frequency of cancers seemed to increase as the number of land-dwelling vertebrates rose, and another increase in cancers occurs once humans* appeared on the scene. Overall, the incidence of cancer appears to be substantially lower in the prehistoric era than in the modern era. There are likely many reasons for this, including fewer environmental toxins, a shorter lifespan, poorer detection … and a significant selection bias (who is or isn’t likely to end up fossilized, which cancers do not show up in fossilized remains, etc. etc.).

*Admittedly, there have not been any cancers found in the Homo habilis skeletons available, but there aren’t a whole lot of them to begin with (and fossilized bones aren’t the easiest way to find cancers). The first documented “human” case of cancer dates to 1.5 million years ago (Homo erectus), but I think it would be foolish to believe that Homo habilis never experienced cancer when it had already been around for millions of years, since the first of the vertebrates.

Tags: comics medicine cancer heroes for hire homo habilis

In this scene from Wisdom #5 (Cornell, Garcia), psychic Maureen Raven gives her erstwhile kidnapper a little taste of her powers. (Take-home lesson for the week: Never kidnap a psychic or telepath. It never ends well and there’s usually a nosebleed involved somewhere).

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed wisdom

Time once more to check in on everyone’s favorite intern, Dr. Dazzler*. This episode comes from Ben Casey #7 (August-October 1963) and examines Dan’s extreme good and/or bad luck. No Mr. Fribble, though.

Click on any of the images for the full story

Discussion questions:
1. Why did the flower pot crash before it even hit the ground? Did Dan knee it with some of his Doctor-Fu?
2. Did Dr. Dazzler cause the truck accident?
3. Does the ambulance driver just drive around aimlessly looking for a doctor?
4. Why is Dan’s uninjured leg in traction? How did he break his right arm — it looked OK to me when he fell backwards?

*Dr. Dan Dazzler was the four-page back-up comic that ran in Dell’s Ben Casey comic book. Further adventures and information on Dr. Dazzler can be found here.

Tags: comics dell ben casey dazzler

It’s Memorial Day here in the United States, a holiday which has come to have two meanings. Traditionally and most important, it is a day set aside in memory of everyone who has died in service to our nation. Realistically, it also marks the more or less “official” start of summer, with most schools out and pools open. In the spirit of this second meaning of Memorial Day, I present this DC comics PSA from 1954 (with repeat appearance in 1959): Tips on Summer Fun. The characters are from the Peter Porkchops comic, which ran for 62 issues starting in 1949.

Click on the image to the right for the full ad.

The writer of this PSA was Jack Schiff with art by Rube Grossman. It can be found in a variety of DC comics from August 1954 and August 1959, including Batman #85, Batman #125, Detective Comics #210, Detective Comics #270, Wonder Woman #68, and Wonder Woman #108.

Tags: comics psa summer peter porkchops wolfie

An uninspired episode with sloppy medicine. It’s a shame that this was the season finale of House. Hopefully they’ll rerun the first and second seasons during the summer instead of the third.

Esteban and Marina, a young couple from Cuba, travel to the United States in a rickety boat to get Marina treated by Dr. House. Their boat breaks down and they are picked up by the Coast Guard. Unfortunately, her medical records are lost in the sea. The couple is coming to America because Marina is “sick” and suffering from a variety of symptoms, many of them quite non-specific. She has been treated by medical experts in Cuba to no avail so her husband “got permission” (from whom?) to bring her to Dr. House for assessment. Her symptoms include fatigue, pain all over her body, cough, dry mouth, double vision, rash, fever, and an elevated bilirubin. The team’s initial diagnoses are rheumatic fever or some sort of infectious disease or parasite. House thinks the symptoms relate to her head, so he orders a brain MRI. He also has Chase evaluate the husband to see if shares any symptoms.

Foreman announces that Marina must have multiple sclerosis (MS) and wants to start her on interferon. Esteban insists that Marina cannot have MS because she was tested for that in Cuba. While Foreman is examining her, he accidentally breaks her wrist by twisting it slightly. Now the question becomes are all her bones weak, or just the left wrist? The team considers osteoporosis and osteogenesis imperfecta (a genetic disease of collagen that leads to weak bones and frequent fractures), but discards them both as she is either too young or too old. Bone cancer is a likely cause of a pathological fracture, so a PET scan is ordered to look for a tumor. A hot spot is seen on the scan, but it is a blood clot and not a tumor. House now wants a cardiac catheterization because he feels that the ultimate cause of any clot is the heart. During the catheterization, Marina suffers ventricular tachycardia then slips into asystole (flatline). CPR is started. House refuses to stop the code or start her on a heart bypass machine until he can discover what caused her heart to stop. He polls a passing medical school class who suggest Marfan Syndrome or botulism from a bad Botox treatment. House discards both ideas. No closer than before to an answer, he reluctantly starts her on a heart bypass machine after she had been coded for three hours.

House tells Esteban that he must say goodbye to Marina because it is time to pull the plug. He shuts off the heart bypass machine, but miraculously Esteban detects a pulse. House switches on the monitors which show a normal heart rhythm. Marina wakes up and is fine, in fact all her pain has resolved and she feels entirely better. She attributes it all to an act of God. House suspects that there must be a congenital defect in one of her cardiac arteries, and inflammation from this has caused her symptoms. He wants to perform another cardiac catheterization, and this time finish the study, to find this abnormality. He talks Esteban into it. The catheterization shows normal arteries, but it also shows what House calls a “third ostium.” This hole between her left- and right -sides of the heart is the cause of all her symptoms, and Marina will be better after a surgery to repair the hole.

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The medical mystery wasn’t particularly interesting because the symptoms were so vague. The show could have used one of the dramatic character introductions it usually features or some of the fancy special effects. Instead it was all symptoms written on a dry erase board. The final solution didn’t seem all that exciting either, even though the writers tried to set it up as “House vs God” (a theme which has been handled better before, and really, couldn’t every episode be described as House vs God?).

The medicine itself seemed particularly sloppy. You’ll notice they never mentioned the MRI results — because that would have been normal, making MS much less likely, and the whole Foreman/interferon scene overkill. While the heart can frequently be the source of blood clots, these are best demonstrated on echocardiogram, not cardiac catheterization — but that echocardiogram would have easily shown the hole in her heart about thirty minutes too soon. Coding someone for three hours is simply ridiculous; CPR is not that effective for that long. Heart bypass machines are used for a few hours during heart surgery, not to keep someone alive who coded. Marina’s heart miraculously restarting on its own was just plain silly (and I don’t care what House thinks, this was never explained. And isn’t she still plumbed into the bypass machine, even if it isn’t on?) I’m not clear on the third ostium bit either. The ostium primum and ostium secundum are openings between the left and right heart that occur in the fetus prenatally. They can sometimes remain open after birth and may require a surgical repair (but do not show symptoms as dramatic as Marina’s). What then is this mysterious “third” ostium, and how would it be any different from the more common atrial septal defect or ventricular septal defect?

I’ve laid off complaining about the Young Guns performing tests they aren’t experienced in, but this episode pushed it over the edge. Since when are the Young Guns (or House) cardiologists and how did they get credentialed to perform cardiac catheterizations? And why is Wilson performing surgery?

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I give the medical mystery a D, because it was boring and uninteresting. The final solution I give another D- because it not only was uninteresting, but made no sense. The medicine was shoddy, sloppy, and often just plain wrong. A good example of the latter half of the season. I give it an F. The soap opera was the best part, but even then — other than the firing of Chase — was too telegraphed. I give it a B-.

The previous House review
A list of all prior House reviews

Tags: television medicine house season finale cardiac catheterization deptal defect

There’s panic in Metropolis! Jimmy signals Superman with his watch, has some adventures, and then a short time later, Superman arrives.

Superman: Sorry I’m late — I was out near Vega when I got your…

Vega is a star that is 25.3 light years from Earth. Just how fast is the signal from Jimmy’s watch traveling to be able to reach Superman in that span of time? Generally speaking, electromagnetic waves (including radio waves) travel at the speed of light and sound waves travel even slower

Vega is 1.49 × 10¹⁴ miles from Earth. Assuming it took the signal 15 minutes to reach Superman, that means that the signal traveled at 5.96 × 10¹⁴ miles per hour, or 1.65 × 10¹¹ miles per second. In other words, the signal from Jimmy’s watch traveled nearly 900,000 times faster than the speed of light (and nearly 150 million times faster than the speed of sound).

That’s quite a signal on that watch (especially when you consider that historically, Jimmy’s watch couldn’t reach through space).

Look at it the other way too: How fast was Superman flying? And can he see where he’s going if he’s moving that much faster than light?

Tags: comics countdown superman jimmy olsen signal+watch