Polite Dissent

Dark Elektra #1

A “cracked inner ear?” There really is no such term — most people would refer to it as a skull fracture or more specifically a temporal bone fracture.

Frankly, the whole sentence is awkward — she specifically mentions which arm bone is broken (the humerus), but doesn’t mention which foot bone was broken (there are quite a few; for all we know it could be a broken pinky toe; which is no big deal for anyone, let alone a resurrected ninja). Of course, this should really come as no surprise as the woman works for Norman Osborn, whose grasp of anatomy is rather poor.

I hate to disagree with Ivy, but her “homeopathic” would not even work on humans — unless you count the placebo effect — because the entire “science” behind homeopathy is pure quackery.

I suspect writer Kevin Smith meant to say “herbal” instead of “homeopathic”. It’s an all too common mistake, as is using the term homeopathic as a general term for non-traditional medicine (see also Vaughan and Bendis), but the terms are not interchangeable and mean very different things (not that you could tell by what is sold as “homeopathic medicine” in you local drug store).

Here’s a quick scorecard:
Herbal remedy — might work.
Homeopathic remedy — expensive water/quackery.

I’ve had several people ask me what I think, medically, of the game Batman: Arkham Asylum and I’m happy to oblige. If posting to the blog seem light this week, you can blame the game.

Overall, it’s a great experience. Though I’m a big fan of video games, it takes a lot for a game to really suck me in to its world completely, and Batman does that (the previous game that pulled this off was the first God of War). The setting, character design, and storyline are all appropriately creepy and the voice acting — especially Kevin Conroy and Mark Hamill — is excellent. Playing the game, I really feel like Batman — I see a crowd of thugs and think, “I can take them, easy,” just like Batman should.

Admittedly, the game isn’t quite perfect:
Riddler’s voice seems flat and tinny, but I just blame this on him using a jerry-rigged radio transmitter.
The final confrontation with Harley Quinn was a definite anti-climax.
Once Poison Ivy joins the big baddies, the atmosphere becomes more cartoony and loses much of its creepiness.

Even with these (admittedly minor) flaws, I’d consider it the best solo super-hero video game.

Season Six of House starts two weeks from today on September 21st, so it’s time to begin this year’s House challenge.

It’s free, it’s fun, it’s easy. Here’s how to play:

To play the full season, your list must be posted in the comments section by 7pm (Central time) September 21st — the night the season starts. Later entries are accepted and will start accruing points the following week.

The spam filter likes to hold on to these lists, so if yours doesn’t appear right away, don’t panic. If it’s been at least six hours and it still hasn’t shown up, drop me a line and I’ll hunt it down.

Here are last year’s final scores.

Here’s an old comic book ad for an over-the-counter pill to stop bed wetting.

The medication is not manufactured anymore — in fact, the company that makes seems to be long gone — but I’m betting it was a medication with strong anticholinergic effects. This pill would, as the ad suggests, tighten up the bladder — but that class of medication can have a lot of unpleasant side effects as well (and the side effects are common enough to inspire a well-known mnemonic: “Hot as a Hare, Dry as a Bone, Red as a Beet, Mad as a Hatter, Blind as a Bat”).

Of course, the bed wetting only stops as long as you take the pill, so it’s not going to “cure” the problem like it apparently has in everyone in the testimonials the company thoughtfully included in the ad. If you’ve been wetting the bed for 23 years, no pill taken for a few days is going to fix the problem. Anticholinergic drugs can also cause dementia in older patients, so I’d be careful before giving it to the 76 year old lady (I’d also want to know why she suddenly developed bed wetting at age 76. Sure, it could be her advanced age, or it could be a sign of something more dangerous).

And what’s with the scare quotes? How is “Bed Wetting” different from bed wetting?

For the full size ad, click on the smaller version or the testimonials.

Welcome to Polite Dissent, my medical/television/comic book blog.

For medical reviews of the television show House, this is the best place to start. Reviews of the new season will start on September 21st, with the first review posted a few hours after the season opener airs.

For medical review of comic books, stroll through the archives, or start here. A look back at the classic medical comics of the ’50s and ’60s can be found during my annual Flashback Weeks.

Finally, for some true stories of medical training, look here.

Marvel Zombies 4 #1 “Midnight Sons, part 1″
Fred Van Lente, writer
Kev Walker, penciler

Morbius may be a snappy dresser and a brilliant biochemist, but he is clearly clueless about vaccines.

Generally speaking, there are five types of vaccines in common use:

Live attenuated vaccines
These are the only vaccines that could possibly cause a disease — but only certain vaccines, and only in certain rare instances. As the name suggests, these vaccines use live, but weakened, germs. The measles, mumps, and rubella vaccine (MMR) falls in this category. It might cause a slight fever or body aches, but it will not cause measles, mumps or rubella.
The varicella (chicken pox) vaccine is also in this category. One in 20 of the recipients of this vaccine will develop a mild rash (usually 1 or 2 pox near the injection site), and a few children with a compromised immune system have developed a full chicken pox infection after vaccination, but there have been no reported deaths associated with the vaccine (unlike actual chicken pox, which prior to the use of the vaccine, killed about 100 people per year in the US).
The vaccine with the highest risk is the oral polio vaccine (OPV), which reverts to the wild-type fully infectious polio virus in about one in a million recipients. Luckily, the OPV hasn’t been used in the United States in nearly a decade (and realistically, before the vaccine, many more than one in a million children contracted polio).

Killed virus vaccines
These vaccines used dead germs to induce an immune response. Since the germs are dead, they can’t cause a disease. Killed vaccines include polio (the current injectable vaccine, not the oral one), hepatitis A, and the flu.

Subunit vaccines
In these vaccines, only a small part of the infectious organism is used — generally a surface protein. Since the entire organism is not present, there’s no way this type of vaccine can cause an infectious disease. Hepatitis B and the HPV vaccine (Gardasil) are examples of this kind of vaccine.

Similar is the conjugate vaccine. In these vaccines, part of the outer coat of an infectious bacteria is combined with a larger protein to make it more susceptible to the immune system. Again, since only part of the germ is used in the vaccine, it cannot cause disease.

Finally, there’s the toxoid vaccines, which are used to protect against toxins put out by certain bacteria such as Clostridium tetani (tetanus) and Corynebacterium diphtheriae (diptheria). Since no germ is used in the vaccine, there is no zero chance of developing a “full blown” infection.

So out of all the vaccines we routinely give, only two even have the “slight chance” Morbius mentions of causing the actual disease. But even that is overstating it: the varicella vaccine has only been shown to cause full blown chicken pox in immune compromised individuals, and the oral polio vaccine hasn’t been used in the United States since 2000. (And you’ll notice that both those diseases are viral, while Morbius specifically mentions bacteria [never mind, see comment #8 below]).

I hope you’re a better zombie fighter than immunologist, Morbius.

OK, I’ll give a little (just a little) away by mentioning that this is the first post-mortem psychic nosebleed I’ve posted.

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed irredeemable mark waid

It’s time to check in again on super-pharmacist and super-hero Bob Benton, this time is a story from Exciting Comics #45 (March, 1946)

All is not right in the home town of Bob Benton (a.k.a. The Black Terror). Several city officials have been found dead of unknown causes. In each case, a strange flower was found beside the body. Benton suspects the flower is a clue and he diligently searches his botanical reference books, but is unable to identify the plant. Meanwhile, the coroner calls Benton after he discovers an unknown poison in the blood of one of the victims. Benton, despite his years of pharmacy training, is also unable to identify the poison.

Arriving back at his pharmacy, he discovers a mysterious package has arrived — a package containing a beautiful flowering plant. The neighborhood cat wanders in and brushes against the plant — and then suddenly falls dead. Benton matches the mysterious flowers found at the murders to the plant and belatedly realizes that the mysterious plant is not just a clue, but the source of the poison. Looking closely at the plant under the microscope, he identifies it as a new variety of gentian, which he claims is closely related to the curare plant.

He tracks down the source of the plants and discovers that the murderer was the city Parks Commissioner who was using the flowers to kill off his rivals so he could take over the city. There is a pitched battle between the Black Terror and the commissioner and his goons. The Black Terror triumphs (this is his story, after all) and the commissioner dies, falling prey to his own poison plants — yet another victim of the Golden Age sense of poetic justice.

Curare is an arrow poison used by several South American native tribes. It can be derived from several different jungle vines, the most common being Strychnos toxifera (which is from the same genus as the plant that produces the poison strychnine, so that should tell you something).

Curare is a paralyzing agent, and, as the name suggests, it kills by paralyzing the respiratory muscles so the victim suffocates to death. The drug wears off after an hour or two, so if the victim were to receive artificial respiration for that period of time, they would survive. Derivatives of curare have been used as part of surgical anesthesia since the 1940s (to allow muscle relaxation during surgery), though they’ve largely been replaced by synthetic alternatives in recent years.

The plants from which curare can be derived and the common gentian share the same order (Gentianales), but are from completely different families and genera so calling them “closely related” is quite a stretch. In fact, gentian extracts are not poisonous, and have been used (generally unsuccessfully) as herbal remedies since the Greeks. Gentian extracts can also be found in various liqueurs, beers, and in the soda Moxie.

Here’s an ad from Action Comics #70 (March 1944) where Superman exhorts his readers to send a dime to help win the fight against infantile paralysis (i.e. polio). This is back when the March of Dimes lived up to its name, and collected dimes to fund polio research.

Click on the image for the full ad

As a added bonus, if you sent your dime in to Superman, you were automatically enrolled in the Supermen of America Club and scored some serious swag including a membership card, certificate, and secret decoder. Best of all, you received an autographed picture of Superman, signed “Clark Kent (Superman)” — which pretty much defeats the whole concept of the secret identity.

Giving credit where credit is due, endemic polio was eradicated from the United States starting with the introduction of the Salk and Sabin polio vaccines in the 1950s — research that was partially funded by the March of Dimes.

More PSAs

Tags: comics medicine psa superman polio march of dimes

You think our doctors use strange and frightening tools and instruments? See what the doctors are using over in the Fifth Dimension:

Here’s the end of the story from the last post. It’s nicely symmetrical: one doctor sends Mr Mxyztplk to Earth, but another one sends him home:

OK, it’s Superman pretending to be a doctor (and pharmacist), but that counts as much as that quack from the Fifth Dimension.
And they managed to work in a “doctors have bad handwriting” joke.
Should Superman be practicing medicine without a license (or dispensing drugs?) Or does that really apply here.
Nice to see there’s another Super-Pharmacist besides Bob Benton.

All in all, a rather unexciting way to start the season. Though, to give the writers credit, they are just starting what seem to be several intriguing plotlines.

The Plot: The episode starts out with head on collision between two cars: a silver one and a black one. A wounded man stumbles out the silver car and runs down the street. He hides in a nearby apartment building and kills man who tries to help him. He then uses a strange machine to change himself into an exact replica of man he killed.

The black car is identified as Agent Dunham’s, but she is nowhere to be found and the evidence suggests no one was in the car at all. Peter and Walter arrive on scene and find a junior FBI Agent Jessup in charge. Walter jimmies the lock of the car open and looks around. As he leaves the car, it suddenly turns on and Agent Dunham comes crashing through the windshield and onto the road. She is rushed to the ER in critical condition. The doctors do everything they can, but Olivia remains in a coma (or maybe brain dead, the writers can’t make up their mind). Later that night, Peter comes in to sit by her, and Dunham suddenly regains consciousness and shouts a line of Greek at him. She has no memory of what happened other than she met with someone somewhere and there is something important she has to do or everyone will suffer.

Peter, Walter, and Agent Jessup team up to track down the driver of the silver car who they determined was purposefully trying to hit her car. Finding a body that matches the driver of the car, only more decomposed than it should have been, they bring it to Walter’s lab for autopsy. The examination reminds Walter of an old experiment he did (what doesn’t?), and he plays a tape of an old ESP project. The subject of the experiment warns of a soldier from another world who has the ability to shapechange, just like the one they are facing now. Belatedly, Peter and Agent Jessup realize the soldier still means to kill Olivia, so they rush to the hospital. Meanwhile, the soldier has killed and taken the appearance of Dunham’s nurse; he tries to weasel some information from her, but when he is unsuccessful, he starts to suffocate her. A couple of bullets from Agent Jessup send the nurse running but Charlie manages to catch her. There are some more gunshots, and when Peter and Agent Jessup arrive, Agent Francis is standing over the nurse’s dead body. Agent Dunham is safe and the soldier from the other world is dead — but is that that what really happened?

1. They Canceled ER, Didn’t They?
A sloppy ER/hospital scene.
“Possible brain herniation” — that’s a secondary diagnosis. What’s causing the brain to herniate? She’s probably bleeding inside the skull from the trauma, which in turn forces the brain down.
Pupils non-reactive — but are they dilated or fixed?
Blood pressure 180/20. Can one really measure of diastolic pressure of 20, particularly in an ambulance? 160 is quite a wide pulse pressure.
Instead of telling the EMTs to “prep her” when she is coding, how about actually doing something about it — like starting CPR?

2. Brain Death or Coma?
Olivia’s sister implies they are going to take Olivia off life support in the morning. What life support is that? Her heart is beating and she is breathing on her own. This isn’t brain death; it’s a coma. There is nothing to stop.

3. It’s All Greek to Me
For the record, here’s what Agent Dunham said: Einai kalytero anthropo apo ton patera toy

4. Eye See You
You can hear the cardiac monitor speeding up, but yet her heart rate on the machine remains the same at 72, a normal reading. While a beta-blocker would lower the heart rate, her heart’s not going fast enough to need one — and you risk dropping the pulse too low.

5. Silent Lividity
A short time after a person dies, their red blood cells settle to the lower parts of the body since there is no longer a working heart to pump them around. This results is a purplish discoloration of the skin which is known as livor mortis, or lividity. It starts at about 1-2 hours, and reaches its maximum at 6-12 hours. It persists after that, but becomes masked by other changes of decomposition. So all it could really tell Agent Jessup was that the victim had been dead around 6-12 hours; nothing to indicate he couldn’t have been in a car accident the day before.

6. Unpalatable
I think they’re confusing the palates. The soldier seemed to be putting the nail-plate directly behind the teeth, which is the hard palate not the soft palate (which is father back in your mouth than you think: feel the roof of your mouth all the way back until it switches from hard to soft).

7. Her Father Wasn’t in Intelligence, Was He?
It takes Agent Jessup several hours after they learn that they are dealing with an enemy soldier to suddenly realize that he is still going to try to kill Agent Dunham? I see she has the making to be just as incompetent an investigator as Dunham herself was last season.

UPDATE: I forgot to mention the “cocktail” Walter mixed to help him sleep. Sleep, hell, that concoction would knock out an elephant! It contained Valium (diazepam, an antianxiety drug with strong muscle relaxant and sedative properties), Haldol (haloperidol, a classic antipsychotic drug which is also a strong tranquilizer), Seconal (secobarbital, a barbiturate and another strong sedative), and lorazepam (Ativan, another drug from the Valium class). Unless he has developed one heck of a tolerance for these drugs, Walter should have been asleep for the rest of the show, if not the entire season.

Though it introduced a new hero, as well as a spooky new villain, the episode was rather “meh”. The medicine was pretty bad, but I’ll give them credit for the typewriter scene, which was cool. The Fringe Doomsday Clock remains where it ended last season, five minutes ’til midnight.

Last week, I discussed a vaccination that prevented you from becoming a zombie. Tonight’s subject is the opposite: a vaccination that turn you into a zombie (actually, it turns you into a mindless super-strong drone, but close enough). This comes from the Pyroman story “The Saboteurs of Steel” in America’s Best Comics #4 (1943).

Evil gangster Ornitz sneaks into a nearby Army base and slips his mind control serum into the paratyphoid vaccine. The next day, the soldiers are vaccinated…

…and they all become the invulnerable super-strong mindless slaves of Ornitz who uses them to take over the Army base.

Can Pyroman stop Ornitz and his army of Army men? Of course he can, this is his story after all. To understand how he does it, it helps to understand the story as a whole:

Paratyphoid fever is similar to the more famous typhoid fever, though it is usually milder. It is caused by a bacteria from the Salmonella family, which is found in contaminated water. It is rare in the United States, Canada, and Europe but fairly common in developing nations. There is a vaccine available, but it not used very often as it is only partially effective.

As the vaccination is labeled “serum,” I suspect the soldiers are getting an immune globulin injection to ward off paratyphoid, and not actual paratyphoid vaccine. In immune globulin injections, the patient receive an injection of antibodies against the disease. These antibodies will circulate for several months, protecting the patient, before eventually breaking down. The patient does not gain any permanent immunity from the injection. This is known as passive immunity, as opposed to active immunity, which occurs when patients are exposed to the germ in question and develop their own antibodies. Active immunity can occur by natural exposure, or by vaccination. All the vaccines routinely given in the United States induce active immunity.

Because there was little — if any — medical mystery this week, the scores were resoundingly low. The only real mystery was why was Annie mute, and why did a music box make her better — a music box that had been sitting on the shelf in the nurses station for who knows how long.

I did give 3 points for the diagnosis of “stroke” in Dr. Nolan’s father, giving it the weight of a clinic patient. Of course, only one participant even suggested stroke, so RGM is the leader with a whopping 3 points. Everyone else is tied for second with 0 points.

Click here to see the full scoreboard.

This was purely a character episode for House, and a pretty good one, at least until it became ridiculously sappy at the end — sappy enough to put a soap opera to shame. There wasn’t that much medicine, which is probably good, because this is a long enough review already.

The episode starts out with a montage of scenes of House locked in a room and undergoing Vicodin withdrawal. Not a very pleasant experience, but he comes through it unscathed.

Now that he has detoxed from the Vicodin, wants to check out of the clinic and resume his previous life. Dr. Nolan, the head psychiatrist of the clinic, confronts House and tells him that he is free to leave, but if he wants the letter of clearance he needs to regain his medical license, he’ll have to attend inpatient therapy. Dr. Nolan points out that it wasn’t the Vicodin that was causing his hallucination, but other deeper problems. Reluctantly, House allows himself to be admitted to Ward Six, the inpatient psychiatric unit.

Dr. Beasley is the young psychiatrist in charge of the unit. Point blank, House tells her that he’s only there until he gets the clearance letter he needs. He threatens to “turn the ward upside down” if he doesn’t get what he wants. He is shown his room and soon meets his roommate, Alvie, a manic depressive (in modern parlance: bipolar) who is in a full manic state because he doesn’t like to take his medications which “bring him down.” (Alvie is a pretty good example of someone who is manic. If anything, he’s more subdued than most manics I’ve encountered.) Alvie introduces him to the other patient including Annie (a mute), Hal (an anorexic), Jay (a claustrophobic) and Richter (a paranoid schizophrenic — probably because he was in all those Revenge of the Nerds movies). They all meet for the first group therapy session, which doesn’t go well, and House finds himself confined to a locked room as punishment.

House rejoins the rest of the patients when they’re outside playing basketball, and quickly turns their psychoses and neuroses against them in order to win the game. House goes back to the ward and encounters Lydia, the sister-in-law of Annie, playing the piano for her. About this time, the orderlies arrive to take him back to the locked room for his behavior on the basketball court.

This time, when House comes out of punishment, he leads a vocal patient rebellion until Dr. Nolan steps in. After things calm down, Steve, a new patient, joins the group. Steve believes that he is a superhero and goes by the name “Freedom Master.” House decides his best bet to get the clearance letter he needs is to find something incriminating on Dr. Nolan and blackmail him. He sends Alvie up to his office, but he can’t find anything. He sneaks a phone call to Wilson, but he refuses to help him.

Now House’s plan is to cooperate, or at least to fake it. He pretends to take his pills and is, to all appearances, getting better and more social. A third psychiatrist, Dr. Medina, wants House to provide a urine sample to prove he is taking his medication. House is ready, though, and has Hal waiting in one of the bathroom stalls to provide a sample. Sure enough, the sample shows evidence of psychiatric medication and Dr. Medina is satisfied.

A little while later, Dr. Medina strolls onto the Ward and confronts Steve about his delusions and the fact that he doesn’t really have superpowers. His extremely confrontational approach angers House, and he becomes even more concerned finding Steve medicated to the gills a short while later. Dr. Nolan steps in. He pulls House into his office and reveals that he knows House has been faking. He had only been getting sugar pills, so his urine should have been clean. Having a positive drug test was proof that he was faking.

Lydia visits later that day, bringing Annie’s old cello. House has Steve help her get the heavy instrument from the car, hoping it will bring back his old super-heroic feelings. Next, he decides that he and Steve should take a ride and he “borrows” Lydia’s car. He takes Steve to a nearby carnival where they have one of those “skydiving over a giant fan” rides (would that really work out in the open like that?). Both he and Steve have fun soaring, and it seems to bring Steve out of his funk — so much so that once again he believes that he has superpowers, and he jumps off the parking garage to prove it.

Steve survives his plummet, but just barely. He has a lacerated spleen and multiple bone fractures. Nolan confronts House and tells him that he is going to transfer him to another psychiatric facility. House is shocked by what happened to Steve and clearly feels guilty. He asks Nolan not to transfer him and promises to comply with his therapy.

House and Nolan start regular one-on-one counseling sessions. He is also started on an antidepressant (an SSRI — serotonin specific reuptake inhibitor. This is a class of antidepressant/antianxiety drug that includes Prozac, Paxil, Zoloft, Celexa, and Lexapro). Nolan takes him to a charity dinner so he can mingle and learn to trust people. Lydia is there, and the two of them have a good time lying and pulling pranks on the other attendees. At the end of the night, she kisses him. Nolan tells House that the night was a success because no one tattled on House’s lies, therefore he can trust other people– which seems a painful stretch of logic to me.

Lydia comes back to visit the next day, but the return of the severely injured and now catatonic Steve to the floor puts a damper on whatever may have happened between her and House. Nolan tells House he needs to apologize to Steve, but he can’t bring himself to do it.

Meanwhile, Dr. Beasley announces that there is going to be a talent show and wants everyone to participate. During group session, House receives an urgent note from Nolan. He meets him at the hospital where Nolan’s father lies in a coma. Nolan tells House that the doctors have told him there is no chance of recovery, but he wants a second opinion. House looks at the CT scans and tells Nolan that his father has had a catastrophic hemorrhagic stroke and agrees that there is no chance of recovery. After being confrontational at first, he pulls up a chair and sits by Nolan as he holds his father’s hands.

Returning to the ward, he finds Lydia by herself crying. One thing leads to another and they end up having mad passionate sex in the office. (Ask anyone: locked ward insane asylum love making is the best kind.) At the talent show, House ends up helping his roommate Alvie rap by stepping in and helping when he starts to stumble over words.

House finally finds the strength to apologize to Steve. He starts to wheel him to group therapy when he notices that Annie is looking down at a music box Steve is holding. He slows down and Steve hands the box to her. She accepts it and opens it.
“Thank you,” she says — the first words she has spoken in ten years.
“You’re welcome,” replies Steve. His first words since the accident.
(And this ridiculously maudlin moment is where all forward plot momentum was lost and along with it, most of the good feelings I had about the story).

Since she is no longer mute, Annie is discharged to an out of state rehabilitation facility. The rest of her family, including Lydia, is going with her. House gets a pass from the hospital and goes to confront Lydia. She tells him that she doesn’t want to leave, but she must because she doesn’t want to break up her family. Nearly broken, House returns to the psychiatric hospital where he encounters Dr. Nolan. Nolan offers to write him the clearance letter he needs — not out of pity — but because House has shown he can change: he cared enough about somebody else to get hurt, and he turned to Dr. Nolan for help when this happened, not Vicodin. The next day, House leaves the hospital and hops on a bus back to his old life.

Not much non-psychiatric medicine this episode, so no major complaints. Minor ones are in blue, nit-picking in green:

Confronting someone with a delusion as strong as Steve’s the way Dr. Medine did is not going to work. Logically, you would think that showing someone that their beliefs are wrong would break the delusion — but by definition, delusions aren’t logical. The mind is very facile and will find a way to keep the delusion despite the evidence. For instance, Steve might now say, “My powers didn’t work because no one was in danger. They only work if there is a lady in distress.” Dr. Medina should know this.
And if you do choose to confront him that way, you don’t do it in public.

Why on earth would you give oral Haldol (a strong anti-psychotic medication. Also a tranquilizer) to someone who’s agitated. First you’ve got to get them to swallow the pills, then you have to wait for them to take effect. It’s much faster just to use injectable Haldol.
And that brings up the ethical question of whether this is an appropriate use of Haldol (my answer: no).

A nitpick here, but House is shown to be receiving 15MG of an unnamed SSRI. It seemed that House was only taking a single pill, but no SSRI comes in that strength. It could be Lexapro, which comes in 10MG, and 15 is a common dose, but that would take a pill and a half

No medical mystery this week, so no grade for it or the final solution. The medicine overall was pretty good, at least until the miraculous cures in the end. I’ll give it a solid B. The soap opera was good — at leas the House part — because it wasn’t as maudlin as Annie, Steve, and Alvie. House’s soap opera gets an A- (everyone else gets a C).

A list of all prior House reviews

I’ve had this public service ad for a while now — the Comic Treadmill sent it my way several years ago — but I’ve never gotten around to using it because for some reason it strikes me as a particularly odd PSA.

I can’t really put my finger on why I feel that way, but I think it has to do with how the teacher explains the situation to the class. There’s no reason the teacher needs to share with them precisely what’s wrong with Tod — if she even knows herself — because it’s none of their business. Still, the way she phrases her explanation seems awkward — if not vaguely creepy.

The moody art by Bernard Baily isn’t helping either.

You can pretty much sum up the lesson of this PSA in one panel: Don’t be a d*ck.

(If you Google “Invisible Handicap,” you’ll find a lot of conditions that lay claim to it: deafness, multiple sclerosis, dyslexia, fibromyalgia, depression, and autism, just to name a few.)

More PSAs

Tags: comics psa binky handicap invisible bernard baily

First off, John Rozum writes some excellent “medical speak” so if you want to know how a comic book Emergency Room scene should sound, check out the Hangman backup story in The Web #1. He knows his stuff (or he knows somebody who knows their stuff and is smart enough to listen to them).

However, that brings us to this scene:

scene from the Hangman backup in The Web #1 (by John Rozum and Tom Derenck)

Spot the error in this Emergency Room scene. It’s a fairly significant oversight; no nit-picking here.

Previous picture quizzes

More exciting than the last episode, but the “big surprise” was obvious barely halfway in. Charlie is seriously creepy though.

The Plot: A small town in Pennsylvania has had seven people disappear in the past four months. Peter talks Agent Broyles into letting the Fringe Team investigate because he feels it may be related to Agent Dunham’s disappearance. Walter discovers a strange thick blue liquid at the scene of the latest disappearance, and Dunham realizes that one townsman, Andre Hughes, a retired doctor, was at the scene of several of the disappearances.

Peter and Dunham question Hughes at his home. Olivia thinks she hears someone else in the home, but can’t find anyone. She does find a fairly extensive lab in the house. They bring Hughes down to the Boston FBI office for questioning. He answers their questions, but refuses to give a blood sample. Dunham discovers that Hughes’s wife and infant son died in childbirth nearly twenty years before.

Suspecting foul play, the team exhumes the bodies of Hughes’s wife and son. The wife’s body is brought to Walter’s lab for evaluation but there is no body in the son’s coffin. It looks like something chewed its way in — or out. A small tunnel is found leading out of the grave into the ground.

Walter’s autopsy reveals that the late Mrs. Hughes had lupus, which he claims made it impossible for her to be pregnant. Closer examination reveals that she had been pregnant as there is still a placenta present; however, closer examination of the placenta reveals human DNA plus something else, apparently scorpion and mole rat DNA. Walter hypothesizes that Hughes used his knowledge of biology and genetics to alter his son while he was still in the womb — to make it more likely that he would survive the pregnancy.

Peter and Dunham suspect Hughes’s mutated son is still alive and living in tunnels under the town. They search Hughes’s house once again and find the partially decomposing corpse of a dog hidden behind a wall in the basement. They also find a recent tunnel with a dead — and gnawed — human body. Just as Dunham is telling Peter what she found, something grabs her from behind. Peter chases after her and there is a claustrophobic fight in an underground tunnel between Dunham, Peter, and Hughes’s mutated son. Peter stabs it through the chest. It tries to escape, only to be crushed by car that falls into the collapsing tunnel.

As the episode ends, Peter and Walter head of to go fishing, while Olivia meets with a mysterious man at a bowling alley who seems to know more than he is telling about the strange symptoms she’s been having since her trip to the other world.

1. A Quick Summation
This episode of Fringe = 65% The Lurking Fear + 30% Tremors+ 5% The Big Lebowski

2. A Silver Platter
Has then ever been an episode of Fringe telegraphed more blatantly? Who didn’t realize who the killer was, once Hughes mentioned that wife and infant son died in childbirth? The episode could have been salvaged by a climactic ending, but it instead it was over faster than the big boss fight in Transformers 2.

3. My Arm is Tingling Therefore I Cannot Move It
Walter seems to be confusing a paralytic with an anesthetic. Numbness is the sign of an anesthetic; not being able to move is a sign of a paralytic. I can numb your hand with lidocaine, but you’ll still be able to move it. On the other hand, I can paralyze you with pancuronium and you’ll be unable to move, but still feel everything.

4. Where’s House When You Need Him?
While lupus makes becoming pregnant — and carrying the child to term — very difficult, it does not make it impossible.
I’m impressed that Walter can find a malar rash on the skin of a corpse 17 years dead.

5. Dig Them Up
Since when do they open exhumed caskets in the open air, in public?
I would have like to see the search warrant/court order for the exhumation Exactly what information did they have on Hughes? An extremely vague note that may possibly if-you-squinted-your-eyes-right suggest he might have something to do with the death of his wife? He was seen near 3 of 7 missing persons? He, according to his constitutional rights, refused to give blood? He has a chemistry set?

6. String Him Up
That was a time consuming and elaborate way to hang yourself. Why not just use your shirt? What was that wire rack anyway?

Bad medicine, an unoriginal story, and another chimera as the bad guy all add up to the Doomsday clock moving one minute closer to midnight

New Avengers #57
Brian Michael Bendis, writer
Stuart Immonen, penciler

New Avengers #57 is the type of comic I like, but don’t see very often: a comic which addresses the effects of super-powers on a character’s medical care. In this case, the issue looks at Luke Cage and his unbreakable skin.

The New Avengers have just been handed a serious defeat at the hands of the Wrecking Crew and some of the villainous cohorts. It wasn’t strictly the Avenger’s fault, they were taken by surprise by some super-power draining technology the Wrecking Crew got their hands on. When the Dark Avengers also showed up, the New Avengers snuck out in the subsequent confusion. Most of the team suffered scrapes and bruises, but Luke Cage appears to be suffering from a heart attack. His teammates rush him to underground “doctor” Night Nurse.

Night Nurse is in serious trouble, and she recognizes it. All three reperfusion techniques require either IV access or a surgical incision. This means that Cage’s invulnerable skin prevents him from receiving the necessary treatment. She tells the team he needs specialty medical care — which is true, and would be true even if his skin weren’t invulnerable. Heart attack patients need to be treated in a facility where there is access to reperfusion techniques.

Even though she can’t break Cage’s skin, there are still treatments that Night Nurse can carry out to minimize the damage from his heart attack:
1. She can give him oxygen. And she does — she also intubates him, which is probably overkill, because there’s no evidence that he is having breathing difficulties. (And the nasogastric tube probably falls in that overkill category as well)
2. She can given him an aspirin, which has surprisingly powerful anti-platelet activity (and more platelets = more clot). Chewing the aspirin is best to get in into the bloodstream quickly.
3. She can give him nitroglycerin, which widens the blood vessels and lowers the blood pressure.
4. She can give him some painkillers. A little IV Morphine is usually recommended for heart attacks — because it also acts as vasodilator and antianxiety agent — but she could certainly give him some pain relieving pills.

Finally, Night Nurse should also place him on a heart monitor and be prepared to defibrillate because it is not uncommon to see nasty and potentially fatal arrhythmias occur with heart attacks (and to her credit, she does place him on a heart monitor).

High score for the week goes to Alex Davis with 12 points. Kevin Lighton is in second with 9 points. Bird Gal, Erin, and Kirsten are all tied for third with 8 points. As it is early in the season, these people also are leading the overall House Challenge.

Click here to see the full scoreboard.

This episode explores what happens when Foreman takes over the team after House quits. And the results are, frankly, dull. The House scenes were good, but the hospital scenes were uninspired. Even the usually humorous theme of “internet medicine is better than real medicine” couldn’t do much more than evoke a tired chuckle

Vince is a game programmer working on a virtual reality first person shooter. He has to drop out in the middle of a gaming session because he suddenly develops a severe burning pain in his hands. He is initially evaluated in the emergency room and told that his nerve conduction studies are normal (so no carpal tunnel) and his bloodwork is negative (which is quite a work-up for the ER). Instead of continuing to work this up as an outpatient, Vince is admitted to the hospital.

Currently, the team consists of Foreman, Taub, and Thirteen. Foreman has taken over the team because House has handed in his official resignation. Cuddy tells Foreman he has one chance to prove to her he can run the team. Looking at Vince’s case, the team suggests diabetic neuropathy (but his HbA1c, a blood sugar test, is normal), hypothyroidism (but no other symptoms match), or complex regional pain syndrome (a difficult to treat cause of chronic pain; previously called reflex sympathetic dystophy). The last one fits the symptoms the best so they plan on treating him with spinal stimulation. When they talk to Vince, he tells them that he has been doing research online and believes that he has mercury poisoning. To placate him, Thirteen draws a mercury level. It is mildly elevated, but nowhere near the toxic level. Nevertheless, Vince still believes that he has mercury poisoning and demands chelation therapy. Foreman steps up and draws the line, informing Vince that if doesn’t want to follow his doctor’s advice, he can do so elsewhere. Vince grudgingly agrees to the spinal stimulation.

The stimulation provides no improvement, and during the procedure, Vince develops a racing heart rate and flash pulmonary edema (the lungs quickly filling up with fluid). Further study demonstrates that Vince has a thickened left ventricle (part of the heart). Lyme disease and cocaine use are the new differential diagnosis. Lyme disease doesn’t quite fit, and Vince denies any cocaine use. Not entirely trusting him, Thirteen and Taub search his office. They find no cocaine, but seeing the realistic rendering of birds in his game, Thirteen suspects he has been in close contact with them and developed psittacosis (also known as “parrot fever,” a disease carried by birds than can be passed to humans). As the team is telling him about the disease, Vince mentions that he is suffering from priaprism — a persistant erection — for the past three hours. The priapism not only requires surgical correction (a shunt), but it also rules out psittacosis.

The new differential diagnosis consists of Guillain-Barre disease (an autoimmune disease of the nerves), thrombocytosis (a disease caused by too many platelets), or a brain tumor. Thirteen favors the tumor diagnosis, but Foreman presses ahead with thrombocytosis, despite Vince having a normal platelet count. He wants to start Vince on hydroxyurea (a medicine used to treat thrombocytosis). At this time, Foreman and Thirteen notice two other doctors — doctors that neither of them recognize — standing next to Vince’s bed. It turns out the other doctors came in response to Vince’s internet postings. Foreman reminds them that neither of them are credentialed to treat patients at Princeton Plainsboro Hospital. One doctor turns out to be a quack, but the other seconds Thirteen suspicion of brain tumor. Vince demands an MRI and Foreman agrees. When the MRI shows no sign of tumor, Vince is started on the hydroxyurea.

Instead of improving, Vince develops massively enlarged cervical (neck) lymph nodes. This should not happen in thrombocytosis. He is started on steroids, which bring down the swelling. Foreman suspects polyarteritis (an autoimmune disease of the arteries), but before the team can act they discover that Vince has posted all his symptoms online and is offering $25,000 to whoever can diagnose his condition. The diagnostic team is inundated with faxes, calls, and e-mails. They confront Vince and tell him that it will take way too long if they have to address every one of the online suggestions (samples include paraneoplastic syndrome, Graves disease, and demonic possession). Vince tells them that he thinks he has amyloidosis, since that’s what most of the people on his site are saying. Foreman agrees to biopsy one of his kidneys looking for amyloidosis, but only if Vince agrees to shut down his website and rescind his reward when the biopsy is negative. Of course, the biopsy is “suggestive” of amyloidosis, and Foreman starts him on dexamethasone (a steroid used, among other things, to treat amyloidosis).

The story isn’t over yet (clearly, as it is has only been 45 minutes), and a short time later Vince is running wild through the halls of the hospital, feverish and hallucinating. Antipyretics (fever reducing medicines such as Tylenol or Motrin) have no effect, so he is placed in a cooling bath. Foreman tells him that Light Chain Deposition Disease (the body overproduces the light chain — part of the antibody macromolecule — and it is deposited in various organs) is the most likely diagnosis, and he will require high dose chemotherapy for treatment. Wearily, Vince agrees. Just as the therapy is about to start, Foreman has his Aha! moment when he realizes that Vince’s fingers never became wrinkled in the bath. This is a sign of Fabry’s disease, a condition caused by the errant deposition of certain lipids throughout the body. His elation is short-lived, however, when he discovers Thirteen has already made the diagnosis and started treatment, based on an internet suggestion she read behind Foreman’s back.

As the episode ends, Foreman is officially put in charge of the team — what little team there is left. Taub has quit to take a surgical job and Foreman just fired Thirteen because he feels he can’t be both her boss and boyfriend. To further complicate matters, House has realized that difficult diagnostic situations are the only thing that keeps his mind off his leg pain and decides to come back to the hospital (after all, it was his suggestion of Fabry’s disease that Thirteen unknowingly used).

I found the medical aspect of the story to be rather uninteresting this week, but whether it was from the weak mystery or lack of House — or both — it’s hard to say. The medicine was haphazard, jumping from diagnosis to diagnosis and lacked the drive most episodes have. Still, there was some logic to it, just not much. Because there wasn’t much medicine, there isn’t much to criticize.

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

I am concerned that the pathologist could not tell the lipid depositions of Fabry’s disease from the protein depositions of the LCDD and Amyloidosis.

The team couldn’t make up their minds whether to play hard with the diagnostic criteria (no joint pain, can’t be Lyme), or loose with them (sure, you can have thrombocytosis — a disease defined by elevated platelet counts — with normal platelet levels). A little consistency would be nice.

Shouldn’t abnormal lipid deposition in the nerves showed up on a nerve conduction study?

There was nothing about this patient’s initial presentation that required inpatient admission. Almost all the work-up, including the nerve conduction studies, should have been done as an outpatient.

While spinal stimulation seems to offer some relief in many patients with CRPS, it is does not work for everyone, and is generally not the first treatment tried.

The medical mystery was only modestly interesting, and never developed the “this guy is on the verge of dying” feeling that makes these shows interesting; I give it a C. The final solution was logical, and generally fit the symptoms so earns an B+. The medicine was stumbling, and seemed to arbitrarily ignore as many logical diagnoses as it focused it; at best, it was average: C. The soap opera, though predictable, was well done and also earns a B+.

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

It’s once again time to visit with Binky and his strangely-garbed young brother Allergy to learn something important from a public service ad. This week, Binky teaches his younger brother how to make friends.

The advice is nothing new: Talk to new people.

There is something ironic about Allergy not wanting to talk to someone “square” — has he looked in the mirror lately?

Given the usual grasp of slang of Silver Age comic book writers (and I’m looking at you in particular, Bob Haney), I suspect that by the time this PSA was published, kids had long since stopped saying “square.”

This PSA is one of DC’s double hits: PSAs that proved popular enough (or deemed important enough) to be published twice. It can be found in DC comics from both July 1957 and July 1965. This particular page was scanned in from Adventure Comics #238. As always, Jack Schiff handled the scripting of this PSA, with Bob Oksner (the artist from the Binky comic) providing the art.

More PSAs

Tags: comics psa binky allergy friends jack schiff bob oksner