Polite Dissent

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

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

It all starts with an experimental anesthetic agent:

And goes downhill from there:

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

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

Scenes from The Spectre #1, by Gardner Fox and Murphy Anderson

Global Frequency #3 by Warren Ellis and Steve Dillon

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

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

Tags: comics medicine nosebleed eyebleed global frequency warren ellis meme

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

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

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

Full scores are available here.

from The Amazing Spider-Man Giant Activity Pad

There have been so many goblins of one sort or another in Spider-Man’s rogues gallery — The Green Goblin(s), Hobgoblin, Menace, etc — it gets hard to tell them apart sometimes. But not today! Which two Hobgoblins are identical?

Ostensibly, this is a public service ad touting the benefits of volunteering, but clearly there are several deeper messages that are even more important:

Click on the image for the full ad

As usual, Jack Schiff wrote this PSA, with pencils by famed Superman artist Curt Swan. This ad can be found in May 1957 issues of DC Comics.
Swan didn’t do the art for many PSAs, the only other one I’ve found so far was a Superman PSA from 1960, “Lend a Friendly Hand.”

More PSAs

Tags: comics psa date jack schiff curt swan

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The medical mystery was good, though would have benefited from the full time, not just the half it got. It deserves an A-. The medicine was sketchy in places, but fit the symptoms better than usual and earns a B. The final solution was clever and (mostly) logical, and earns another B. The soap opera was the star of this episode, and was very good. I give it an A.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Because of the nonsensical psychic powers, the complete misunderstanding of basic science, and pretending an electrocautery machine is an oxygen machine, I have no choice but to resume the Fringe Doomsday Clock countdown, and the hands move up a minute to 11:56.

Click on the image for the full ad

At what point does “hard boiled” become “sell out”?

From Action Comics #137 (October 1949)

Returning to the world of Starship Troopers, the story of the kidnapped psychics continues. As you can see, it’s not a pretty picture.

Starship Troopers #10, scenes by Christian Beranek, Jim Boswell, Cy Dethan, and Scott James

All previous Psychic Nosebleed Zen posts

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

Continuing a Polite Dissent Easter tradition:
the Peeps Titans wish you a Happy Easter!

Previous years have featured the Justice League Peeps, the Peeps Avengers, the Legion of Super-Peeps, and last year, the Uncanny X-Peeps.

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

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

Full scores are available here.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Another week of bad science, and characters acting, well, out of character. The Fringe Doomsday Clock gains another minute and stands at 11:57 (meaning that all the gains from the good episodes before the break have been lost).

Reviewing last month’s comics today, that’s our motto here at Polite Dissent
Oracle: The Cure #1 Home Again, Home Again
Kevin Vanhook, writer
Julian Lopez and Fernando Pasarin, pencilers

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

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

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

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

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

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

Action Comics #679 is a fairly slight story as Superman goes. There’s a little bit of super-hero/super-villain fisticuffs, but most of the issue is spent catching up with the diverse cast of Superman supporting characters, from Lois to Lana to Lex II to Mae. The super-hero aspect of the comic is a direct sequel to Hawk & Dove #13 and features the villain Shellshock, who has the power to make things explode just by speaking their name.

Like I said, the story all started in Hawk & Dove #13. Ruth Spencer is the aunt of supporting cast member Kyle, and the black sheep of his family. She was a protestor during the Viet Nam war and she and her friends were responsible for blowing up a munitions factory. A handful of people died in the explosion, including one of Ruth’s co-conspirators and best friends, and she has been on the run ever since. While she paid a surprise visit to her nephew in Washington D.C., a strange costumed villainess named Shellshock — who bore an uncanny resemblance to Ruth’s dead friend — appeared and attacked. At the end of the evening, Shellshock disappeared and Ruth went back on the run.

Four years later, Superman is visiting Washington DC when he encounters Shellshock. They battle in the skies over the city for a while before she pulls her usual escape trick: speaking her own name and exploding. As coincidence would have it, Shellshock isn’t the only one visiting Washington that day: Ruth Spencer is there as well and notices the battle overhead. Later, while grabbing a newspaper from in front of a toy store, a doll in the window of the store comes to life and morphs into Shellshock. Ruth tries to talk to her, but Shellshock just flies off toward the center of the town, causing explosions as she goes. Superman comes flying in when hears the commotion and once again he and Shellshock battle. It all comes to a head in front of the Viet Nam memorial when Superman, Ruth, and Shellshock all come face to face. The truth is finally revealed: Shellshock is not Ruth’s dead friend, but instead a manifestation of Ruth’s own previously unknown psychic powers fueled by her guilt over the people who died in the factory explosion. Finally understanding the truth about Shellshock, Ruth realizes that she can’t run anymore and turns herself in.

For Hawk & Dove fans, there’s a scene with the comic’s SCU supporting cast including Lt. Wolfson, mechanics Mike and Ike, and sharpshooter Lt Trinh. They fill Superman in on some of the back story including the mysterious murdered of their boss, Captain Arsala, and his missing girlfriend Dawn (if these events are unfamiliar to you, I must regretfully point you in the direction of Armageddon 2001 #2). Superman muses to himself a little about Hawk and Monarch before flying off.

Unlike the Kesel written Hawk & Dove, this appearance of Shellshock is written by Roger Stern, and his version of the character is a little different. In her initial appearance, Shellshock was a woman a few words and only spoke when she wanted things to explode. One got the idea that she chose her words carefully because anything she said would cause an explosion, making conversation difficult. Stern’s version is more loquacious, and is able to talk at length without causing explosions. She plots behind the scenes and even soliloquizes at a few points in the story. I prefer the original version, but Stern’s version has some undeniable poignancy, especially with the revelation that Ruth had a brother who died in the Viet Nam War.

All Previous Hawk and Dove Reviews

from The Amazing Spider-Man Giant Activity Pad

As if the Hobgoblin wasn’t enough, now it’s time for the Green Goblin…which one is different?

Again, this one’s may be 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 Goblins in question.

Since I’ve been taking a brief look back at Hawk and Dove recently, I thought it would be an appropriate time to look in on their arch-foe Kestrel. Last time he was seen was in Secret Six #7, along with a whole mob of other B- and C-list (and D-list, who’re we kidding?) villains trying to capture the Secret Six and reclaim the “Get Out of Hell Free” card.

First we see him leaping (in a very Liefeld-esque style) at the van containing the majority of the Six.

Then it quickly becomes clear that his plan didn’t work out so well…

With Earth Day in just a few days, this is the perfect time for a nature-themed Public Service Ad. That this ad contains cad-supreme Wolfie is just a bonus. (Plus it features bats. Lots and lots of bats.)

Click on the image for the full ad

This PSA was written by Jack Schiff, with art by the guy who always draws Buzzy PSAs, artist Win Mortimer. This PSA was found in Adventure Comics #158, but can be found in other DC comics from November 1950.

Another Earth Day PSA
More PSAs

Tags: comics psa buzzy wolfie nature jack schiff win mortimer

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You just know I’m going to get all sorts of unfortunate spam because of this post

Tags: comics medicine azrael medication statin fabian nicieza

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

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

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

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

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

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

Sadly, the giant termites never actually participated in the robberies, or the story would be have been that much more awesome.

This story, “The Man Who Betrayed Himself,” is found in America’s Best Comics #26 (May 1948).

More Black Terror (super-pharmacist in action!) stories

Tags: comics medicine black terror bob benton pharmacist cacobane termites

I’ve just upgraded to the latest version of WordPress, so if anything seems wonky (or wonkier-than-normal), let me know.

from The Amazing Spider-Man Giant Activity Pad

We’re done with goblins*, so this week the focus is on anther member of Spider-Man’s rogues gallery: find the Electro that doesn’t match the others. This one’s easy, so no hints from me.

If you want another Electro challenge, try this.

*until next week, anyway

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

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

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

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

More PSAs

Tags: comics psa dennis the menace poison mr wilson ruff

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

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

Full scores are available here.

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

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

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

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

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

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

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

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

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

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

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

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

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

MRIs aren’t used to diagnose a broken nose.

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

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

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

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

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

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

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

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

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

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

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

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

Comic Books:
Warning The Public About Swine Flu since 1947

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

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

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

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

Norman Osborn:
Psychopathic megalomaniac
Qualified anatomist

This issue was brought to my attention by snell of Slay, Monstrobot of the Deep!!
He was also kind enough to provide the scans of the comic.

Tags: comics medicine avengers norman osborn clavicle dan+slott