Polite Dissent

Marvel Zombies 3 #1
Fred Van Lente, writer
Kev Walker, penciler

Jennifer Kale is a sorceress and member of Florida’s state super-hero team, the Command. They are sent to investigate strange happenings in the middle of the Florida swamp only to discover the first stages of a zombie attack from another dimension. In just a matter of minutes, her team is attacked and decimated by zombie Deadpool and his cohorts. Jennifer is the only one who manages to escape, but she is injured in the process:

1. The flexor digitorum profundus is a muscle of the forearm that is required for fully flexing (bending) the fingers. It is a deep muscle, located right against the bone on the underside of the forearm. The muscle is used to flex the distal aspect (the far portion) of the fingers, but also plays a role in flexing the rest of the hand.

2. Flexing the fingers certainly seems to be an important part of spell casting in the Marvel Universe. For one thing, it’s impossible to make Dr. Strange’s classic casting technique of Ditko-fingers without flexing the fingers. From what I’ve seen, Jennifer Kale has a similar casting style. While I don’t have her earliest appearances in various Steve Gerber Man-Thing stories, in more recent years she has shown up in the absolutely horrible mini-series Witches, and there she uses a modified flexed finger technique.

3. I don’t think that zombie Deadpool’s shot was as good as he thinks it was, but even if I’m right, it wouldn’t affect the eventual outcome:

It’s not clear to me that Deadpool injured Jennifer’s flexor digitorum profundus. The injury seems to be on the upper-medial side of the forearm, while the flexor digitorum profundus is in on the lower medial side. His shot seems more likely to have affected the extensor muscles, but they seem equally important to Marvel universe spellcasting, so the ultimate result would have been the same.

The tendons of the flexor digitorum profundusdon’t start that far back anyway; his shot would have hit the belly of the muscle (though severing that would have pretty much the same effect as cutting the tendons).

Finally, remember that the flexor digitorum profundusis a deep muscle. The flexor digitorum superficialis lies on top of it, and any injury that severs the profundis would have to go through the superficialis as well. Of course, the flexor digitorum superficialis is another important muscle in flexing the fingers, so the outcome would be the same — but you’d think the always chatty Deadpool would have mentioned he was severing two muscles for the price of one.

4. Even in our non-magical world, flexor digitorum profundus injuries are repairable, so assuming Jennifer survives the Zombie onslaught, she should be able to regain full use of her fingers after a surgical repair.

As Superboy points out, winter is here (at least in the northern hemisphere), and so everyone’s thoughts turn to shoelaces. Well, that’s what Superboy suggests anyway — read the full PSA to discover why.

This PSA appeared in various DC comics in January 1952 including Action Comics #168, World’s Finest #56, and Wonder Woman #51. The script is by PSA-meister Jack Schiff, with art by the prolific Win Mortimer.

More PSAs

Tags: comics psa superboy shoelaces jack schiff win mortimer

In the morning, as I get ready for work, I tend to watch Headline News. It’s quick and concise, though admittedly a little light on details sometimes.

They also run lots of ads and soundbites for their own evening shows. In particular, they run frequent clips of Nancy Grace, their so-called “legal analyst.” Several times each morning, they run an ad featuring this sound bite from her:

“When you’re pointing a finger at someone, you have four fingers pointed back at you.”

What? How? I can’t believe this is the sound bite that they chose to run every day for her — it’s blatantly wrong. For one thing, it’s not clever or original — school teachers have been saying it for decades — only they’ve been saying it right: when you point a finger at someone, you have three fingers pointing back at you. The only way you can have four fingers pointed back is to have some sort of weird double jointed thumb.

It seems her grasp of anatomy is on par with her grasp of the law.

Blue Beetle #34 “Boundaries, Part Six: Monopoly”
Matthew Sturges, writer
Rafael Albuquerque, penciler

At the end of the previous issue, Dr. Polaris zaps Blue Beetle (Jaime Reyes) with a particular potent burst of magnetic energy, knocking him to the ground and — gasp! — killing him.

However, as is common in comic books, particularly among title characters, death is not always fatal.

When Dr. Polaris can find no heartbeat in the Beetle, he flies off. Since Polaris’s magnetic powers should be able to detect any cardiac electrical activity, it’s safe to say that Jaime’s heart is not functioning at all — in other words, he is in asystole (or flatline, if you prefer).

Time for Blue Beetle’s armor, the scarab, to work its mojo:

Epinephrine (otherwise known as adrenalin) is one of the recommended treatments for asystole. As shown, 1 milligram delivered intravenously is the standard dose in this setting. You’ll notice the author, correctly, did not have the scarab shock the flatline — which is a nice change.

The epinephrine works — it restarts the heart, but unfortunately it excites the heart too much and knocks Jaime into ventricular fibrillation, a potentially fatal heart rhythm.

The preferred treatment for ventricular fibrillation is to shock it (the machine is called a “defibrillator” for a reason — it is used to stop fibrillation). Quick treatment is key and the chance of successful resuscitation decreases by 5-10% for each minute defibrillation is delayed. With rapid defibrillation, the success rate of treating ventricular fibrillation nears 85%. The scarab follows through appropriately:

360 joules is the recommended setting for the treatment of ventricular fibrillation, at least when using a monophasic machine. Newer machines use biphasic defibrillation, which is felt to be superior (it has a higher success rate at any given energy level), but there is no recommended setting for these machines — it varies by manufacturer. Apparently for the scarab, it’s 360 Joules.

After 4 1/2 years of medically reviewing comic books, it’s nice to see one finally get the treatment of asystole correct.

Marge Bannerman has a problem. Her father runs a carnival freakshow but an unscrupulous competitor has lured all his freaks away, and her father is now on the verge of going bankrupt.

She goes to her friend Bob Benton for help because she knows that a pill can solve any problem¹.

Luckily Bob has just the thing for her — the latest wonder drug: Camiana. He gives her a bottle of the pills and she returns to the carnival^2.

She asks the single remaining freak to take the pill, and he agrees. A little while later, in the middle of his act, the pill kicks in and he lights up like a glowing skeleton³

Bob Benton: That drug is a wonderful aid! It lights up the human form, and may well prove as great a discovery as the x-ray!

This sight brings the customers in droves and soon the sideshow is making money hand over fist⁴. Once again, medicine saves the day.

Notes:
1. Kidding! Kidding! Sometimes it takes liquid medicine instead of pills.
2. It sure sounds like he’s prescribing medicine without a license
3. This certainly doesn’t look healthy to me; if anything, it looks suspiciously radioactive. The unfortunate guy doesn’t look to happy about it either. I have a feeling he’ll end up like one of the poor radium girls.
4. Of course, the comic’s not quite over as it is a “Black Terror” story, and not a “Bob Benton, pharmacist” story. Like any Black Terror story, this involves a tremendous number of fist fights and the Terror getting hit over the head and knocked out at least once (seriously, the Black Terror is worse than Black Canary).

This was a free comic produced by DC Comics and Schering in 1999. Although generally well written and illustrated, the underlying concept makes this a very bad comic.

A rare white orchid is on display at the black-tie dinner at the Gotham City Botanical Gardens and Bruce Wayne (Batman) and Tim Drake (Robin) are there to keep an eye on it. The reason? Poison Ivy has recently broken out of prison and this is just the kind of plant she likes to steal. Sure enough, she shows up and Batman and Robin spring into action. Unfortunately Robin is so sedated from his over-the-counter allergy medication that he lets Poison Ivy escape with the orchid.

When Batman and Batgirl head out to track down Poison Ivy and the orchid, Robin wants to come along, but Batman grounds him because of his antihistamine-related grogginess. Robin starts to sulk, but Alfred sends him to his doctor who prescribes him a non-sedating antihistamine (Claritin, of course — this was published when it was a prescription-only drug). Thanks to his new medication, Robin is able to conquer his hay fever and avoid sedating side effects; he joins the battle just in time to redeem himself by capturing Poison Ivy and rescue the orchid.

As giveaway comics go, the story by Christopher Priest is quite well done and Joe Staton handles the art well. What keeps it from being a good comic is the fact that Batman is selling drugs. Batman. Is. Selling. Drugs. Look, I don’t mind using super-heroes on occasion to sell something: subscription, Hostess snack cakes, Underoos, etc. I understand that bills have to be paid. But I draw the line at using super-heroes to sell drugs, even ones as innocuous as Claritin. There are some lines that just should not be crossed.

Sorry Jimmy, but I don’t think you’re going to survive this adventure.

The straw Jimmy is using is simply too long and too narrow to work. That means that there is too much flow resistance to get the old air out and fresh air in. Instead, he’ll end up breathing in the same oxygen-deprived air he just breathed out, and within a minute or two he’ll pass out. Since he’s underwater, that’s likely to prove fatal.

There’s a reason snorkels (and endotracheal tubes) are wide and relatively short.

images from The Amazing Spider-Man #113 (October 1972) by Gerry Conway and John Romita

It’s good to see Dr. Bromwell again, and nice to know that he’s still performing house calls. One of the implications here is that Peter has pulled one over on the good old doctor, who of course is not aware that all of Peter’s numerous problems relate to him being Spider-Man.

But on the other hand, who’s to say Dr. Bromwell isn’t right? It wouldn’t surprise me to discover that in addition to being Spider-Man, Peter has an ulcer, just like the doctor says.

You can tell the time frame this was written by Dr. Bromwell’s approach to the diagnosis and treatment of ulcers. For the better part of the twentieth century, it was believed that ulcers were caused by a combination of high stress and poor diet. Later, increased stomach acid production was suspected as the underlying cause. Then, in the last twenty years or so, it was discovered that most ulcers have an infectious cause — a nasty little bacteria known as Helicobacter pylori (more commonly called H.pylori). Thus current treatment for ulcers includes acid reducing medication in addition to a course of strong antibiotics.

Dr. Bromwell seems to be firmly in the first camp: ulcers are caused by stress and a poor diet. He tells Peter that he is too tense for someone his age, and then tells Gwen what food he can and cannot have.

The main treatment for ulcers at the time of this comics was antacids, which were available over the counter. Some physicians at the time mistakenly prescribed anticholinergic medications (which are good for other gastrointestinal problems, but not ulcers), and this is probably what Dr. Bromwell is sending Harry out to get.

As for his “further tests,” Dr. Bromwell is talking about an Upper GI, where Peter would drink a contrast solution like Barium, and then an x-ray would be taken and examined for the tell-tale sings of ulcers. Today, upper endoscopy (an EGD) is the most common method of diagnosing an ulcer.

I can identify Ms. Martian and Mind Grabber Man, but the rest just seem like generic psychics.

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed final crisis grant morrison

Several common themes resurfaced time and again in DC Comics’ PSA ads. I’ve already mentioned the “stay-in-school” theme as well as the “United Nations” one. A third common theme is the “kids act while adults complain” theme. In these ads, the adults whine and moan and complain, but don’t actually take constructive steps; the kids, on the other hand, always decide to “act for the good of the community” by the end of the page. Today’s ad, “Know Your Community,” is a perfect example of this kind of PSA.

This PSA was written by Jack Schiff with art by Win Mortimer, who not only drew all the Buzzy PSAs, but the Binky ones as well. This ad could be found in a variety of December 1953 DC Comics including Action Comics #187, the source of this scan.

More PSAs

Tags: comics psa binky jack schiff win mortimer

It’s nice to have House back after the winter break, but I wish the second half of the season had started with a stronger episode, not this lukewarm time waster.

Jeff is a 32 year old patient with a 3 year history of chronic pain. It started as abdominal pain, but now he also has severe headaches and muscle cramps that come and go. He has seen seven specialists since his symptoms started, but a cause has never been found. He is on high doses of narcotic pain medication with poor pain relief. As the episode starts, he writes a farewell letter to his wife and son and tries to commit suicide, but they come home unexpectedly and find him. He is rushed to the hospital where he is admitted to House’s team.

Thirteen suggests fibromyalgia, but the idea is quickly shot down as Jeff’s symptoms do not match the recognized criteria of the condition. Taub suggests that the patient’s pain is psychosomatic, probably due to an undiagnosed depression. House has Taub run a “pain profile” (i.e. depression screening) on the patient, and Foreman and Thirteen search his house. The search turns up some metal polish — which can cause nerve damage (but the patient worse wore a respirator) — and a freezer full of quail. Quail-related food poisoning (coturnism) can cause rhabdomyolyisis (a disease caused by rapid muscle breakdown). Taub continues to think that the pain is psychosomatic, but House disagrees, believing that Jeff’s depression is caused by the pain and not the other way around. He orders a muscle biopsy to rule out rhabdomyolysis.

In the middle of the biopsy, Jeff complains of sudden right arm pain and his blood pressure drops dangerously low. Kutner announces that he is in “arrest” — though whether it is a cardiac arrest or a respiratory arrest is never clarified (though later comments suggest it was a respiratory arrest). He is found to have a pulmonary embolus by a ventilation/perfusion scan. The differential includes a hypercoaguable state (patients that clot easier than normal) or a cancer syndrome (Trouseau Syndrome is mentioned). Since House is not around, Foreman orders a CT scan of the patient’s chest, abdomen, and pelvis in an attempt to find a suspected tumor. No tumor is found, but edema (swelling) is seen in the intestines and air is seen in the intestinal blood vessels. Kutner suspects that Jeff may have a blockage in his superior mesenteric artery which has blocked blood flow to the intestines and damaged then. Thirteen points out that blood clots elsewhere in the body may be causing his pain. Foreman orders an angioplasty of the artery. Hearing the symptoms, House intervenes and points out that the patient had blown air into his IV, causing an air embolus in a suicide attempt. This is what caused the intestinal edema, air in the intestinal vessels, the pulmonary embolism, and respiratory arrest.

The differential now includes non-motor seizures (discounted because the EEG’s have all been normal) or a glycogen storage disease (an inherited enzyme deficiency) such as McArdle’s Disease. An ischemic forearm test (a test designed to uncover the enzyme deficiency) is performed. It doesn’t show any evidence of the glycogen storage disease, but during the test the pain moves from his left arm to his left leg, the first time that it’s ever jumped like that. The possibility of disc disease is mentioned once, then never again. The team now wants to decide once and for all whether it is psychosomatic pain or there is a physical cause. A total spinal block, high in the spinal cord, is given. This is supposed to separate the mind from the body. If the pain is gone, then the cause of the pain is physical (because the connection between the nerve ends of the body and the pain areas of the brain has been broken); but if the pain remains, then the cause is in the brain (because it doesn’t involve nerves of the body, thus breaking the connection would have no effect). The test relieves Jeff’s pain, but not entirely. This puzzles House because the test results should be all or nothing.

A short time later, House and his team are called to the floor when Jeff’s son Zach starts writhing on the floor, screaming in pain. Jeff’s wife is scared that Zach may have what Jeff has, but House recognizes it as a distraction to cover Jeff’s latest suicide attempt — drinking a bottle of isopropyl (rubbing) alcohol. He is started on dialysis. With the failure of the spinal block to clearly identify a cause, the team now considers Fabry’s Disease (another inherited condition), syphilis, or opiod induced pain (his pain medications are worsening his pain). House decides the last is the most likely, and forces narcotic withdrawal in the patient by giving him naloxone, an narcotic blocking agent. It doesn’t work, and Jeff’s wife convinces House to let Jeff be discharged home with the understanding that he is going to attempt suicide again once he gets home; this time with her blessing.

A short while later, talking to the handyman who is fixing his apartment, House has his “Eureka!” moment and deduces that Jeff has epilepsy (yes, I know they dismissed the idea earlier, but bear with me here). It started three years ago as a seizure in the muscles of the testicle but then spread to the brain’s sensory region and somehow “rewired” the neurons of the brain. It didn’t show up on EEG, House says, because the nerves to the testicular muscles are in the “deep” area of the brain. With treatment for his seizures, Jeff is cured and lives happily ever after.

This seemed to me to be a relatively weak episode medically. There aren’t many specifics I can point at and say they got wrong (but not much I can say they got right either); it’s more of an overall impression. Part of the problem is the vague symptoms — is the patient’s pain all over (as frequently stated) or specific to certain areas (as it seemed to be whenever the plot required). Admittedly, chronic pain conditions are difficult to diagnose and treat, but this was a little too much.

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

Now IANAN (I am not a neurologist), but there was so much about the final diagnosis that just didn’t make sense to me. For instance:
While the testicles may be “deep” in the body, the nerves for the muscles controlling them are located on the motor cortex, just like all the other skeletal muscles in the body. They are not too deep for EEG.
Somehow these seizures “rewired” the pain sensors in Jeff’s brain — but apparently only temporarily as the pain keeps moving. If they’re rewired you’d think they’d stay rewired rather that spontaneously un-rewiring.
Since this was a brain-related cause of pain, shouldn’t the spinal block have had no effect, not a partial one?
Some of the most common medications used to treat chronic pain are seizure medications. You’d think one of his seven specialists would have tried them at one point.

As is becoming more common, the diagnoses suggested are way off from the patient’s actual signs and symptoms. McCardle’s Disease, Fabry’s Disease — really?

I think it’s pretty clear that neither Foreman, the nurses, nor the writers have any idea what a double blind experiment actually entails.

Speaking of no idea, Cuddy’s right: the team (and floor nurses) seem to have no idea what “suicide precautions” are. What were they, 0-2 for the night?

The medical mystery was one of the least interesting cases yet (if not the most boring in 5 years), so deserves a mere D, and just because I’m feeling generous. The final solution hurt my mind trying to understand, and earns another D. The medicine was scattershot and unenlightening, but not much worse than the season’s average so earns a C-. The soap opera was…adequate, barely. C.

The most damning thing I can say is that there were no great House lines or moments that made me chuckle — for the first time ever.

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

Dogma-Central, Ron, and Sconibulus all scored the high score this week: 12 points.

Overall, Sable Hope remains in the lead with 39 points. Dogma-Central jumps up to second with 37 points. Ash drops to third with 36 points. Sconibulus makes a strong move to fourth with 33 points, and JockM is in fifth with 32 points.

Full scores are available here.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A very low scoring game this week.

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

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

Full scores are available here.

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

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

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

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

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

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

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

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

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

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

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

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

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