Polite Dissent

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

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed wolverine charles xavier

This public service ad from 1952 offers a great example of how much the language has changed in subtle ways over the past 50 years. In this ad, the term welfare wagon is used in a positive light, meaning “helping others within the community.” Nowadays, the term is still in use, with several connotations, none of them particularly positive.

In the book Comic Book Nation: The Transformation of Youth Culture in America, the author proposes that this PSA has “Superman himself endorse a program of national social welfare.” I think that’s reading a bit much into the ad. To me, while Superman seems to be advocating some form of community welfare, it is a combination system of both private and government programs (he refers to “taxes” suggesting a governmental approach; but the hospital is having a fund drive, which suggests non-governmental funding), and one more locally based than national is scope. Overall, I think Superman is just proposing that “neighbors help neighbors”, whatever the system.

This PSA was written by Jack Schiff with art by Win Mortimer. This ad could be found in DC comics from Jun 1952 including Batman #71, Superboy #20, and Action Comics #187, the source of this scan.

More PSAs

Tags: comics psa superman welfare jack schiff win mortimer

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

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

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

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

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

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

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

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

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

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

Other Comic Book Transfusions

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

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

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed backlash taboo virtual bob

My wife and I sat down to watch the new Wonder Woman animated movie this weekend and both thoroughly enjoyed it. The plot is straightforward: it’s a re-telling of Wonder Woman’s origin and her first trip to the “Man’s world” after being raised entirely on Themyscira. Along with returning Steve Trevor to America, she also must battle the machinations of Ares, God of War.

The voice acting is good, though it took me about an act to get used to Alfred Molina as Ares — I kept hearing him as Tevye (if only he had broken into a rousing rendition of Tradition). The main flaw to me was that Steve Trevor was a rather lightweight character with frat-boy morals, and it was hard to see him being at all attractive to Diana. (And where did an isolated Bronze-Age society come up with an invisible jet?)

Now I’m not saying it’s genre-redefining film by any stretch of the imagination, but it’s a solidly enjoyable super-hero movie with a hint of a female empowerment theme. My wife (Wonder Woman knowledge level 1/10) seemed to enjoy it as much as I (Wonder Woman knowledge level 7/10) did — she even specifically mentioned how much she liked it, which is an unusual thing for her to say about an animated film. Our nineteen-month-old son was even able to sit still and watch it for twenty minutes in a row — the first time he’s done this for a show that wasn’t the Backyardigans. There were some intense battle scenes in the beginning and end of the movie that I wouldn’t let him watch, so bear that in mind when watching it with kids.

1. Batman Beyond: Return of the Joker [Uncut Version]
2. Justice League: The New Frontier
3. Wonder Woman
4. Batman: Mystery of the Batwoman
5. Batman: Mask of the Phantasm

Another Buzzy public service ad, and another “Stay in School” lesson. It’s a common topic in old DC PSAs, though admittedly an important one. This one is better than most; I appreciate the “Don’t Quit When You’re Discouraged” message — I know I’ve fallen prey to that more than once.

This PSA was written by Jack Schiff with art by prolific Buzzy PSA artist Win Mortimer. This PSA was found in Action Comics #167, but can be found in other DC comics from October 1954.

More PSAs

Tags: comics psa buzzy school jack schiff win mortimer

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Full scores are available here.

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

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

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

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

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

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

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

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

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

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

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

Identify these first lines to famous (and possibly infamous) comics:
Hint: All are from first issues (or maybe a zero issue or two), or the beginning of a well-known storyline.

1. Coffee tastes like your dog took a leak in it.

2. Good evening Slumburg! You’re tuned in to the WSLM Listener Line and we’re tuned in to you!

3. It is because of the accursed Thor that I am exiled to this barren isle, ordered to remain here by Odin, king of the gods.

4. In the beginning there was only one, a single black infinitude…so cold and dark for so very long…that even the burning light was imperceptible. But the light grew, and the infinitude shuddered…and the darkness finally…screamed as much in pain as in relief. And in that instant a multiverse was born.

5. roaringraringracing haring home on the homestretch now and the wind in my ears as the sound of the crowd 200 on the speedo…210…215…220…and oh the sky runningspilling blue smoke everything moves so slow and I should have seen it the oil slick i should have saved it

6. Good evening London. It’s nine o’clock and this is the Voice of Fate broadcasting on 275 and 285 in the medium wave…it is the fifth of the eleventh, nineteen-ninety-seven.

7. Mad Hettie? We got it for you.

8. Good morning ladies and gentlemen. My name is Guy Gardner and I’m a Green Lantern. Correction, I’m the Green Lantern. None of the other jerks can hold a candle to me.

9. You are looking a the entrance to Fogwell’s Gym on New York’s lower west side! It is here that our story begins…a story different from any you have ever read before!

10. There is a city. A glorious and singular place. Old and yet pristine. Ornate and yet streamlined. A metropolis of now and then and never was.

11. For the love of Dallan, my Prince! The Acroyear Air Patrol dog our heels.

12. It’s raining in Washington tonight. Plump warm summer rain that covers the sidewalk with leopard spots. Downtown, elderly ladies carry there houseplants out to set them on the fire escapes, as if they were infirm relatives or boy kings.

13. The comet appeared out of nowhere, catching Earth’s early-warning systems off-guard. If it was a comet! Ground based radar tracked it down, losing it finally in the lower altitudes over West Virginia! A seismograph registered its impact in the Allegheny Mountains. Tomorrow somebody from the university will investigate — if there is a tomorrow. By then it may already be too late!

14. Man. I am Metron. Have no fear. Here is knowledge.

15. Sales of the book are around 300,000. Good, not great. Good enough to get this editorship — still low enough to need it. The “Crimewatch” section. Christ, what a title. Why is everything “watch” around here?

16. I don’t belong. Not here. Not now. I have to get back there. The bet was rigged, he made me believe. Now there’s darkness in my soul. I want to die…again.

I’m out of town this weekend, so I’ll post the answers — if there are any unanswered ones remaining — on Monday.

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

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

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

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

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

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

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

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

I’m enjoying my last day of vacation, so I thought I’d dig out this classic DC public service ad I first posted a few years ago: “How Not to Enjoy a Vacation.”

There’s really not much I can ad to the dog’s narration, so just pay attention to what he’s saying.

This ad was first published in October 1957, then was republished in August 1963. The script — as always — is byJack Schiff, with Ruben Moreira on the art this time.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

All previous Psychic Nosebleed Zen posts

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

from The Amazing Spider-Man Giant Activity Pad

Again, this one’s a little tricky because of the black-and-white-on-newsprint didn’t scan all that well. Because I’m a nice guy, click here to see an enlarged higher-quality image of the four spinsters in question.

*Sadly, I’ve already used the Skrull and clone jokes.

While I’ve published more public service ads starring Buzzy, DC’s other teen leading man Binky appeared in his share too. This one is about compromising to make things happy at home.

Seems to me that Mom and Pop screwed up, and are using fancy footwork to cover up their mistakes and suggest it’s the kids’ fault. Way to go Mom and Pop! (Once I would have meant that sarcastically, but now as a parent myself I simply stand in awe of their skillful maneuvering).

Binky’s younger brother Allergy has had the wool pulled over his eyes if he thinks his family constitutes a democracy. Another point to Mom and Pop.

This PSA was written by Jack Schiff and had art by Bob Oksner, Binky’s regular artist. I came across it in Action Comics #144, but it can be found in other DC comics from May 1950. It was also reprinted as the January 1954 PSA.

More PSAs

Tags: comics psa binky home jack schiff bob oksner

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

Full recap can be found here.

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

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

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

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

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

The newest member of the Polite Dissent family:

Makenna
Born 2:33 pm, weight 6 lbs 15 oz.

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

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

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

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

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

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

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

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

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed punch jewelee joker fool

from The Amazing Spider-Man Giant Activity Pad

This one’s way too easy, so no hints or giant-sized versions.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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