Polite Dissent

Zombie Terry Long

And if you don’t know who Terry Long is, consider yourself lucky.

I found this the best episode of the season, so far, and one of the better ones overall. There were certainly scientific mistakes, but it was nice to see some of the “police procedural” scenes well done, fo once

The Plot:Officer Gillespie, a policeman in Philadelphia receives a mysterious phone call from the “Colonel” and is told to head to a nearby subway station and stop a man in a black trenchcoat with a black briefcase. When the officer spots the suspect and tries to grab the suitcase, he suddenly begins to crystalize. Gillespie screams in pain, then explodes, killing all around him

The Fringe Team is called in to evaluate the Philadelphia explosion because no evidence of any explosive material can be found. Poking around, Walter finds some crystallized parts of Office Gillespie, and realizes that it was the officer that exploded. He takes the bodies back to the lab for autopsy. As he pieces the crystallized officer back together, he finds needle marks between the toes — Gillespie had been injecting himself with some unknown medication.

Meanwhile, Peter takes the subway station surveillance tapes to one of his contacts, because the tapes all were strangely full of static. Peter’s friend is able to remove a little of the static but not much, so what led up to the explosion of Gillespie remains unclear. His friend speculates radio wave interference caused the static. Later, Peter and Dunham are talking to the officer’s widow when Dunham stumbles across a hidden case consisting of a syringe and a strange injectable medicine.

Across the country, Captain Burgess, once a military officer, now a suburban housewife, is seen injecting herself with the same medication. Later that day, the Colonel appears and tells her she is needed on a mission to Washington D.C. He provides her with airline tickets and hotel reservations.

Dunham and Peter discover that the Gillespie was part of an experimental medical program while he was stationed in Iraq. They travel to Iraq and track down one of the doctors who worked on the program, which was developed to produce an antidote to the chemical agent cyanogen chloride. The experiments weren’t very successful — only four out of 200 patients survived. Plus there was another unfortunate side effect: the serum turned the users into human bombs if they were exposed to a certain radio frequency.

Back in the United States, Broyles in charge of taskforce put together to capture Captain Burgess and the Colonel. They track her to a Metro station in Washington. Peter spots the Colonel and a brawl begins. Dunham is able to shut down the radio signal the Colonel had been sending just in time to stop Burgess before she exploded.

Back in FBI custody, the Colonel tells Broyles that he was trying to stop the “others” — who were planning a war and passing intelligence by a network of couriers. In the end, we see a courier hand a briefcase to the Observer, who opens it to reveal surveillance photos of Walter.

1. A Quick Summation
The idea of a person being turned into an explosive device is clever, but I just don’t see how it would work. Where would the energy of an explosion that powerful come from — even if the person were injecting a strange medication and turning to crystal? I just don’t think there are that many high-energy bonds to break in a human (particularly since the explosion left behind identifiable pieces). Admittedly, this is all “back of the envelope” math so I could be wrong, but color me suspicious.

2. Deus Ex EMP
Does an “EMP disabling device disable” EMPs, or is does it utilize EMPs to disable devices?
If the former, wouldn’t the EMP disabling device itself be disabled by an EMP?
If the latter, how did it know which device to disable or when to activate? It can’t be “always on”.
Regardless, if the device scrambles all radio waves, you wouldn’t be able to listen to the radio or talk on your cell phone inside the station.

3. Moses Supposed his Toeses are Roses
The webspace between the toes is used by addicts to inject drugs because the track marks are harder to find. It is commonly used by medical personnel who are addicted.
Captain Burgess’s injection was horrible as she has apparently never heard of sterile technique. There are nasty germs on the soles of the feet, why invite them into the body?

4. Just Like Detective Comics
Cyanogen chloride is a nasty chemical weapon. It acts as both an irritant (to the skin, mucous membranes, and respiratory tract) and a cyanide agent. Like most cyanide agents, it is quick acting (less than 10 minutes, usually). Treatment involves skin decontamination and use of cyanide antidotes.
With treatment, the chemical is cleared from the body quickly, there would be no need for continuing injections. And even if the soldiers were lied to about the serum, their own NBC training should have raised questions.

5. Video Killed the Radio Star
316 megahertz is technically UHF, not VHF, and falls in the band controlled by the government.

While there was questionable science this week, the episode score points by actually showing some detective work (though mostly by Peter, Dunham — as usual — stumbled into clues) and having an enjoyably suspenseful chase at the end. The Doomsday Clock gains a minute, and goes back to five ’til midnight.

Power Girl #5 “Space Girls Gone Wild”
Jimmy Palmiotti, Justin Gray, writers
Amanda Conner, penciler

Power Girl is caught in the middle of the explosion of a spaceship that crashed in a city park. The local police, firefighters, and EMTs rush in survey the damage, provide first aid, and move her out of the crater.

They’ve got her on oxygen and they’re using a backboard, so everything’s good right?

Not quite. They forgot to secure Power Girl’s head/neck and if there’s any damage to the cervical spine or cervical spinal cord, this could be a big problem (what sort of problem? Quadriplegia). The image above shows the danger perfectly. Look at the angle her head is at compared to the rest of her body.

Here’s an annotated version to make it even clearer:

I suspect the rescue personnel were a little distracted.

High score for the week goes to TRad with 13 points with Elizabeth second with 12 points.

Overall, TRad is in the lead with 20 points. Kevin Lighton is second with 17 points, and Theta Sigma is third with 4 points. Tied for fourth with 13 points are atg and Elizabeth.

Click here to see the full scoreboard.

A good episode of House, with a nice turn by Thulsa Doom, full of many layers of moral dilemmas. Plus, if you ignore the scenes dealing with the heart, the medicine was pretty good.

Dibala, a brutal African dictator suspected of genocide, is in the United States to address the UN when he suddenly starts coughing up blood (or vomiting blood — it’s not entirely clear). He is admitted to House’s Foreman’s team at Princeton-Plainsboro for evaluation. The team’s initial differential diagnosis includes hemorrhagic ulcers of the lung, an assassination attempt using polonium (suggested by the dictator), and acid reflux. Foreman notices a bug bite on the patient’s hand and thinks he had has malaria. House, on the other hand, thinks the bump is not a bug bite but instead chloracne indicating dioxin poisoning (probably from an assassination attempt). Foreman goes with House’s idea and starts Dibala on Olestra (the same “fake fat” once used in no-fat potato chips. It is thought to increase fecal excretion of dioxin — i.e. it makes you poop more).

Dibala suffers a heart attack. He is started on oxygen, heparin (a blood thinner), and streptokinase (a “clot buster”). He survives, but since the heart is now involved and he has also developed a low grade fever, the team revisits their differential diagnosis. They now focus mostly on infectious causes including Lassa fever, Ebola, Marburg, and trypanosomiasis (African Sleeping Sickness). Once again, Foreman goes with House’s suggestion and starts the patient on ribavirin to treat Lassa fever. Dibala’s staff bring in an expatriate who has survived Lassa fever. They want to use her blood to help treat Dibala (they will presumably inject her antibodies — which would include antibodies against Lassa — into Dibala, providing him with passive immunity). Cuddy agrees over Cameron’s dissent.

Meanwhile, an opponent of Dibala has sneaked into the hospital and attempted to assassinate the dictator. The shots miss, but while evaluating Dibala, Chase notices a right eye hemorrhage. Further evaluation shows that an enlarged lymph node has blocked the retinal vein, leading to the bleeding into the eye. With lymph node involvement, the differential changes again and now consists of sarcoidosis, a Staph infection, and lymphoma. The lymphoma seems the most likely, so a biopsy is checked, but turns out to be completely normal. When Chase and Cameron tell Dibala the results of the test, it becomes clear that he is having problems with his short term memory. House suspects scleroderma is the cause, but Foreman suggests blastomycosis, a fungal infection (the argument here seems confusing to me: Chase says he agrees with Foreman, but then says he doesn’t think it is fungal). This time, Foreman sticks with his choice and starts Dibala on Amphotericin B, an antifungal medication. Cameron begins to have second thoughts that maybe it was scleroderma after all. Some blood tests are run which show that Dibala is positive for anticentromere antibodies (a test for scleroderma). As Foreman points out, it’s not a perfect test, but it does strongly suggest that scleroderma is the cause. Taking this into account, Foreman stops the Amphotericin and starts steroids to treat the scleroderma.

The next time we see Dibala, he is bleeding copiously from his mouth and nose. Chase is using a bronchoscope to look down into his lungs to find the source of the bleeding. He is able to cauterize one bleeding area, but another appears, and then another and another. It is too much for Dibala and his heart stops and he flatlines. Foreman calls for the paddles and the patient is shocked and shocked and shocked and shocked — all the while blood is pouring from his mouth and nose. It’s no use though, Dibala is dead.

After it’s all over, Foreman is mulling over the case and can’t decide what mistake he made. Was he too stubborn, or not stubborn enough? He wants to recheck some tests, but Dibala’s body is locked in the morgue. He discovers Chase visited the morgue earlier in the day and realizes that the blood tests for scleroderma did not come from Dibala at all, but from an elderly patient who died of the condition. Chase had purposefully misled Foreman so that Dibala would get the wrong treatment and die.

The medicine, for the most part (i.e. ignoring the cardiac scenes) was fairly sound. But, oh, those heart scenes dragged it down.As usual, major complaints are in red, minor in blue, nit-picking in green:

I’ve discussed shocking flat lines many times before — and I’m going to do it again — but with a twist: Dibali’s problem isn’t that his heart has stopped, it’s that’s he’s losing massive amounts of blood — which in turn is leading to the heart stopping. No amount of shocking (or anything) is going to restart the heart until the bleeding is stopped and blood replaced. It probably would not have been a bad idea to try some other maneuvers before declaring him dead (epinephrine or atropine, or CPR), but as I mentioned above, it wouldn’t have made a difference unless they stopped the hemorrhage first.

A recent bleeding problem (i.e. in the last six weeks) is a relative contraindication to the use of thrombolytic (clot busting) therapy. In another words, while not an absolute no-no, think twice before doing it. Dibala had some significant bleeding in his lungs just a day or two before — is using streptokinase really a good idea?
Regardless, you don’t give heparin with streptokinase (other thrombolytics, yes, just not streptokinase).
You’d think they’d use a newer thrombolytic at a cutting edge hospital like Princeton-Plainsboro.

You don’t give Amphotericin IV push — it’s too dangerous. Quoting the FDA: “rapid intravenous infusion has been associated with hypotension, hypokalemia, arrhythmias, and shock.”

The incubation period of malaria is at least seven days, usually longer. The mosquito bite mark should have gone away by then.
To be fair to Foreman, it’s quite a stretch for House to consider a single bump on the hand chloracne.

Anticentromere antibodies tend to occur in the more limited, milder forms of scleroderma. This should have given Foreman more reason for pause.

The mirror box is a relatively new technique for phantom limb pain, and while it does show promise, it doesn’t work that fast (it takes multiple treatments) or that completely.

The medical mystery was good this week — lots of unexplained bleeding usually is — though not terribly original. It earns a B+. The final solution generally fit the symptoms, and had a nice twist, so earns another B+. I have mixed feelings about the medicine overall. Most of it was quite good, but two scenes were particularly bad. I wish I could split the score, but I can’t (well, it is my site, so I guess I could — but I won’t), so I give the medicine a weak C. The soap opera was very good. There was House/Wilson, House/Neighbor, House/Foreman, Foreman/Thirteen, Chase/Cameron, Chase/Dibali, Cameron/Dibali, and of course, Foreman/Chase. It deserves an A.

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

Worried about global warming? Spending sleepless nights fretting over the mass extinctions of animal and plant species not to mention the destruction of vast areas of their native habitats? Looking up at the sky everyday to check for holes in the ozone layer?

Once you read the public service ad you won’t worry any more, because you’ll realize: mankind — we’re #1!

This PSA is found in DC comics from June 1958 as well as October 1962 (Woohoo! Even better! We’re #1 twice!). As always, this public service ad was written by Jack Schiff, this time with infrequent PSA collaborator Bob Brown on art.

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Tags: comics psa nature jack schiff bob brown

from the cover of Angel #23 (by Lynch and Urru)

What’s the error in this picture taken from the cover of Angel #23. It may be a little subtle, but once you catch it you’ll kick yourself. (And for the record, the interior art does not share the same mistake.)

Previous picture quizzes

An exciting episode of Fringe that did a nice job advancing the overall plot. The action and suspense were well done, but the medicine was rather abysmal.

The Plot: A cryogenic storage facility is robbed and a truckload of frozen human heads is stolen. Four security officers are killed in the robbery — well, actually it’s three officers killed and one shape shifter. The Fringe team is called after the last corpse is found bleeding a silver colored liquid. While Walter inspects the corpse, Peter mentions that this is the third cryogenic facility robbed in the last week, and every time, only human heads are stolen.

Back at the lab, Walter has Agent Dunham drink a concoction of ground up flatworms to help restore her memory of her time on the parallel Earth. It seems to work as she begins to have brief flashbacks as the episode progresses.

Walter finishes the autopsy and discovers that the shape shifters’ blood is 47% mercury. He realizes that there was only trace mercury in the previous body they thought had been a shape shifter (the Nurse from the first episode), so that means the shape shifter who tried to kill Olivia is still out there.

Walter and Peter to hunt down Rebecca, the girl from the ESP video (first episode again), to see if she can still detect the shape shifters with her psychic powers. She tells them her powers faded a few years ago, but she agrees to repeat the experiment to see if her powers will return. She returns to the lab and is dosed with a variety of hallucinogens.

Meanwhile, Agent Dunham takes the device found on the dead shape shifter to the lab at Massive Dynamics. They tell her they can use the new device to repair the damaged device from the first shape shifter and will be able to generate an image of who he is disguised as now. They’ll have the results sent to Walter’s lab and Olivia’s phone.

Back at the lab, Dunam collapses and has an extended flashback to her time in the other universe. She remembers William Bell telling here that there is a war coming and he needs her to guard the gate between the two worlds. He tells her the shape shifters are looking for a certain person — a leader who can open the gate — and that’s why they’re after the frozen heads; one of them is the leader. Later, when Dunham is telling Nina Sharp of her recovered memories, Charlie calls to inform her that Nina is the shape shifter. She all but runs out of the building and encounters Charlie outside. Just then, her phone rings and sends her the results from the device that reveal that it is Charlie who is the shape shifter. There is a brutal fight, and at the end, Dunham shoots him, repeatedly. And then she learns that the other shape shifters have found their leader. This is what we call a downer ending.

1. The Worm Turns
Ah, the famed planarian experiments from the 1950s. A “scientist” trained some of the flatworms to run a maze. He then killed them and fed their remains to a second group of flatworms. This second batch of flatworms was found to be able to run the maze faster, suggested that they had gained the memories of the worms they ate. This experiment was actually featured in one of the greatest comic books of all time (Saga of the Swamp Thing #21 — “The Anatomy Lesson”). Trouble is, it’s not true. While the story of the experiment persists as a myth/urban legend, few actual scientists believe the results are valid. Over the intervening fifty years, no one has been able to duplicate the results despite repeated attempts. The current suspicion is that the positive results of the initial experiment were due to either observer bias (the tests weren’t double blinded), or the fact that the worms were following the slime trails left by the initial batch of worms.
Even if the experimental results were valid, why would that apply here? By drinking all the flatworms, shouldn’t Olivia have gained flatworm memories, not her own?

2. The Medicine Cabient
Salvia – a native Mexican plant with hallucinatory and dissociative properties. Currently legal in the U.S., but maybe not for long.
Phenothiazine - medically, it refers to a class of antipsychotic drugs derived from the chemical phenothiazine. The chemical itself isn’t really used in medicine, but is used as a dye, insecticide, and livestock dewormer.
Valium – a benzodiazepine. A relaxant and sedative. Addictive.

3. A Bad Resuscitation
How is turning Olivia’s head to the side going to open her airway?
Nitroglycerin relaxes blood vessels and drops the blood pressure. How’s that going to help Olivia?
30cc is a large amount of medication to give. If oral, that’s a shot-glass full of liquid to get down an unconscious person. If intravenous or intramuscular, that’s a hell of a lot to get in. Most IV or IM medications are 1cc or less.
I know I’ve mentioned this before several times (including a previous episode of Fringe), but despite what you’ve seen on Pulp Fiction, shooting adrenalin into the heart is a bad idea. It’s a blind stick and you could easily miss the heart, or worse, rupture one of the coronary arteries and cause a heart attack. There are other options for giving adrenalin: inject it into a blood vessel, or squirt it down the throat.

The story was good, but the medicine was bad, so it’s a wash and the Doomsday Clock stays at five ’til midnight

UPDATE: Oh look, I’ve made a Fringe landing page. It’s plain now, but I’ll fancy it up soon.

Amazing Spider-Man #600

When evaluating the pupillary response in a patient, have them take off their sunglasses first.

Invincible Iron Man #14

We already know that Norman Osborn is no good at anatomy, but it turns out he is clueless at computer science as well. Here, when he is trying to convince the Russians to allow him in their county to look for fugitives Tony Stark and Pepper Potts, he refers to “picobytes of…data.”

There is no such thing as picobyte — it is impossible. A byte is made up of 8 bits*, and a bit is as small as you can subdivide a byte. A “picobyte” then, would refer to one trillionth (10^-12) of a byte, which is orders of magnitude smaller than a byte can be divided.

I assume Osborn meant to say “petabyte” (a quadrillion bytes) — or maybe he meant Pikabyte, the loneliest of the Pokemon.

*There have been computer systems in which a byte is more or less than 8 bits, but 8 bits is standard now, and it was never more than 36 bits-per-byte.

High score for the week goes to Alex Davis and Linda Pollock both with 7 points.

Overall, TRad retains the lead with 23 points. Alex Davis moves to second with 19 points. Kevin Lighton drops to third with 18 points. Elizabeth remains in fourth with 15, and atg and Theta Sigma are tied for fifth with 14 points.

Click here to see the full scoreboard.

An interesting premise initially on this week’s episode of House, but a slight episode over all. It was in many ways a rehash of House vs God, only not as clever

Jack Randall is the son of a billionaire. He has been sick for over a week with worsening abdominal pain, fever, dehydration, diarrhea, and weight loss. He has seen a variety of doctors, the last who prescribed intravenous antibiotics for a presumed case of Clostridium dificile (i.e. “C. diff” — a cause of severe antibiotic-related diarrhea). When it became clear that Jack did not have C. diff and was not improving, his father brought him to Princeton-Plainboro Hospital demanding that he be seen by House. Cuddy, as always, acquiesced (she has become the Neville Chamberlain of hospital administrators. Didn’t she used to have a backbone?)

House wants the team to start over from the beginning with the history and physical. While performing the physical exam, Cameron feels a left-sided abdominal mass. This is confirmed by an x-ray and revealed to be a fecal impaction (a big hard ball of poop) revealing that Jack is severely constipated. This is a new finding, as previous x-rays were normal. The team decides that this represents toxic megacolon due to Hirschprung’s Disease (a congenital condition caused by missing nerves in one section of the intestine). They want to perform a barium enema and colon biopsy to confirm. Jack feels much better after the procedure and disimpaction and is laughing and joking. Suddenly he begins staring straight ahead and then breaks into a convulsive seizure. Foreman gives him some diazepam (Valium — among its other uses, it is good at stopping seizures). An examination of the eyes reveals swollen optic discs, a sign of intracranial hypertension. Foreman orders furosemide (Lasix – a diuretic, i.e. “water pill”) and then orders more diazepam and then some phenytoin (Dilantin — another seizure medication). He is worried that Jack’s intracranial pressure will get so high the brain will herniate, so he rushes him into surgery where Chase drills burr holes in the skull to relieve the pressure.

Jack is looking a little better after the operation, but the team notices that he is building up fluid in his brain and abdomen again. Closely examining the head CT, Foreman notices an irregularity in the way the fluid is building up and finds this suspicious for early brain cancer. House concurs. A biopsy is taken, but it is negative. Now House suspects that Jack has adenocarcinoma (cancer) of the stomach, and this is what is causing his symptoms. Jack has another bad seizure, but this time with a normal intracranial pressure. The team gives him some diazepam to stop the seizure and proceeds with the scope — but there is no sign of gastrointestinal cancer either. In the meantime, Jack has fallen into a coma. Chase suggests the cause may be infection caused by an antibiotic resistant germ, but all the cultures have been negative. Cameron suggests that Jack may be having abdominal epilepsy — in other words, he has seizures, but they show up as severe stomach pain, and this then in turn led to his other symptoms. House agrees and Jack is started on gabapentin (Neurontin, an anti-seizure drug). An EEG (brainwave) evaluation is started but reveals no seizure like activity. However, Cameron notices that Jack has developed a rash all over (and I mean all over) his body.

The differential diagnosis of Jack’s condition now includes an allergic reaction to his medications, autoimmune disease (lupus and vasculitis), or polyarteritis nodosa (another type of autoimmune disease). House considers starting Jack on Prednisone to treat the polyarteritis, but when Cameron tells him that the rash is also on the genitals, he deduces that Jack has Degos disease, an incurable terminal disease caused by inflammation and blockage of small and medium sized blood vessels. House breaks the news to Jack’s father and lets him know that Jack has less than a day left to live. Jack’s father decides to invest all his assets in extremely risky ventures, knowing he will lose everything. He has decided that by doing so well in business, he has tempted fate and his family is suffering. Therefore, if he is ruined financially, his karma will even out and Jack will improve. House mocks him, but doesn’t stop him (and apparently makes some money on it). As the financial papers are signed, Jack has a cardiac arrest and flatlines. The team is able to resuscitate him, but it’s touch and go. Talking with Wilson a short time later, House has one of his patented aha! moments and realizes that Jack does not have Degos, but has Primary Antiphospholipid Syndrome. They give him some heparin and immunoglobulin and he miraculously recovers.

The medicine had some problems this week. As usual, major complaints are in red, minor in blue, nit-picking in green:

I’m no neurosurgeon, but I don’t think you just whip out your trusty Ryobi cordless and drill a burr hole like that.
At the very least, clean the skin first — I don’t want any nasty skin bacteria pushed into brain which is what you are drilling into.
Also, a sudden drop in an increased intracranial pressure is likely to cause a brain herniation — the very thing they were trying to avoid.

This is the second episode of the season (and we’re only four episodes into the season) where the misdiagnosis of the patient was made by biopsy.

While writing the script for the classic film noir The Big Sleep, the screenwriters couldn’t figure out who murdered the chauffer. They called up Raymond Chandler, who wrote the original book, and ultimately he admitted the plot was so complex that he didn’t know either. I think this happens in House a lot when the writers get lost in their own plot. Case in point — the seizures: First they suggest the increased intracranial pressure is causing the seizures (could happen). Then they suggest electrolyte imbalances could cause the seizures (could happen) — but if the latter is the case, then what caused the increased intracranial pressure in the first place?
The team kept referring to the abdominal fluid returning or recurring. What did they do to remove it in the first place?

Furosemide is, at best, a second-line agent for treating increased intracranial pressure. If you’re going to use a diuretic, acetazolamide is the best choice. Mannitol is a good choice as well.
Cameron’s suggestion of intubation and hyperventilation was another good option.

Phenytoin 500MG is not an unreasonable dose to break a seizure in patient who weighs 60-80 pounds.
I notice Cameron only ended up giving 50MG. Was this a continuity error in the script, or willful disobedience on her part? And 50MG would be an appropriate dose for an 6-10 pound child, way too little for this kid.

If your patient with C.diff is a previously healthy kid, with no recent antibiotic use, and no record of C.diff exposure, and he requires oxygen, then your C.diff case does not have C.diff.

I defy anyone to get a good fundoscopic exam on a seizing patient in the middle of a brightly lit room. Can’t be done.

You’d think after six years, Jennifer Morrison would know how to pronounce ascites.

Labs don’t run extra blood tests without an order. Especially tests that require prep, like fasting before a cholesterol test.
Here is another example of the writer’s trying to have it both ways. If the lab ran the tests, then there would be a computer file with results, not just a single piece of paper. But if Chase ran the test himself so there was not a full computer record, then who ran the extra tests?

I thought the medical mystery was interesting this week and deserves a B. The final solution fit fairly well, though I think Degos fit better. I give it another B. The medicine overall was average, though there were some positive signs — like the team actually performing a history and physical. I give it a C+. The soap opera was okay. Nothing great, but nothing out of character either. It earns a C.

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

A common theme of DC Comic’s public service ads in the 1950s and ’60s was support for the United Nations. This was from an era when the relationship between the US and the UN was much less contentious than it is now. I thought this was an appropriate ad because it features both Iran and the UN, which have been in the news frequently lately, albeit for vastly different reasons.

The four planes representing Iran’s “United Nations Friends” are labeled US, USSR, India, and Pakistan.

Based on when this PSA was written, I suspect the planes are spraying DDT, which — depending on your view of Rachel Carson and Silent Spring — may very well have caused more problems than it solved.

This PSA scores a hat trick and is found in DC comics from December 1950, March 1955, and November 1963. This particular ad was scanned in from Adventure Comics #202 (March 1955) This PSA was written by Jack Schiff with Win Mortimer on art.

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Tags: comics psa united nations iran jack schiff bob brown

When and why did placing the hands on either side of the forehead become the official pose of telepaths and other comic book psychics?

I figure there are several possibilities why:
1. The brains of psychics are heavier than normal — especially when using their powers — and they need the extra support.
2. It’s an aiming device.
3. Psychic powers cause migraines and they’re massaging the sensitive spots.
4. It increases downforce, in case one of those pesky psychic winds comes along. It also helps them in cornering on banked tracks.
5. They close their eyes when concentrating and it prevents them from bumping into anything if they start walking around.
6. It prevents a psychic nosebleed.

As for when , as far as I can find (in my admittedly brief search), it goes back to X-Men #3 (January 1964):

The science, while a little sketchy, wasn’t half-bad in this episode of Fringe. Despite this, I found the story itself rather lackluster.

The Plot:In Seattle, Greg, a businessman, walks through his office, late for a meeting with his boss. As he moves through the office, he notices that everyone he sees has the heads of demons rather than their proper heads. When he enters the conference room, he sees that his boss is also a demon, so he bludgeons him to death with his briefcase. The co-workers who wrestle Greg to the ground notice that his eyes are cloudy and twitching.

The Fringe team is called to Seattle to evaluate the case. They interview Greg at the hospital and he tells them what he saw in the office. Suddenly, he begins thrashing wildly in bed, his hair turns completely white, and he collapses, dead. Walter assists that local medical examiner with the autopsy and determines that Greg died of “acute exhaustion.” He arranges for the body to be sent to his lab at Harvard for a more complete, Walter style, autopsy.

Talking with Greg’s wife, Dunham and Peter learn that he had a history of sleep walking, but it hadn’t been a problem for several months since visiting some specialists.

A second incident has occurred: a woman driving a mini-van told her husband she saw a monster and drove her car into an innocent cyclist. She died at the scene and was found to have the same white hair Greg did.

Back in his lab, Walter finds a microchip implanted in Greg’s midbrain. A quick look at the body of the second victim shows an incision on the neck suggesting she had the same operation. Broyles takes the microchip to Nina Sharp at Massive Dynamics who identifies it as a chip designed to work on the thalamus to promote sleep. She identifies its creator as a Dr. Nayak, also in Seattle.

Dunham and Peter pay Dr. Nayak a visit. He identifies both victims as patients of his who are taking part in a clinical study on the brain chip. He takes Dunham and Peter to his office only to finf there has been a break-in. Nayak’s office has been trashed and the computers containing all the patient data are missing.

Walter and Peter hypothesize that someone is using the chips as a rudimentary form of mind control. Meanwhile, in a dark room, we see shadowy someone access the clinic’s computers and select a patient — a waitress at a local Greek restaurant. Soon she begins hallucinating before attacking the chef and then collapsing, dead. Nayak identifies her as one of his patients as well.

Back on the east coast, Walter has been experimenting with the chip and discovers that it siphons the patient’s dreams away so that they never dream. The chips can also be used to place the patient in a dreaming state while awake. Finally, he discovers that whoever is on the receiving end of the chip gets an incredible high from the stolen dreams. Olivia realizes that they are looking for someone addicted to the dreams. A brief amount of detective works reveal that Dr. Nayak himself is the perpetrator. He has a dream-addicted dark side that is causing all the problems. They track him to his home just as he is using his machine to activate the chip in an airline pilot’s head. Dunham destroys the computer, saving the pilot (and his crew and passengers), but killing Dr. Nayak in the process.

1. Wherein I Make Some Concessions
I agree that exhaustion/stress can cause high cortisone levels and dehydration. For the sake of the story, I will also accept that it can cause sudden loss of hair pigment (a la Jean Valjean) and thyroid disorders. However, I am at a loss to explain how it can cause the sudden appearance of large patches of thickened flaking skin. Sure, dehydration and low thyroid can cause skin problems, but it is the entire skin, not just large discrete patches.

2. We Solve the Problem by Breaking the Space-Time Continuum
Let me get this straight: the brain chip is used to correct non-REM sleep disorders. It does this by siphoning off dreams. Now, dreams generally occur in REM sleep, which comes after non-REM sleep. So the chips fix the sleep by removing something that hasn’t even occurred yet.

3. Department of Redundancy Department
“Blood CBC” is hopelessly redundant. CBC stands for complete blood count, so a blood CBC is a blood complete blood count.
A CBC looks at the blood cells (white, red, platelets). It doesn’t look at hormones like thyroxine and cortisol, that’s a different test entirely.

4. OMG, n00b
Yes hackers steal passwords. They also mount DDOS attacks, but these are two separate things. Claiming the lack of DDOS attack means that a hacker couldn’t be involved means the FBI (or the Fringe writers) need much better forensic computer experts. (And what would a DDOS attack against a single clinic server accomplish, anyway?)

5. It’s Not Brain Surgery — Wait, Maybe It Is
The thalamus is located deep in the center of the brain. Any surgery to reach it, let alone implant a chip in it, is going to be a major undertaking — a hole in the skull needs to made after all — and wouldn’t be performed as an outpatient clinic procedure.
The thalamus is part of the diencephalon, making it forebrain, not midbrain.
And good luck getting the clinical trial approved by the IRB.

6. Your Suspicions Are Suspicious
Hearing that one of his employees was suspected, one would think that Dr. Nayak would have volunteered the information about his assistant being missing earlier in the day, rather than waiting until the end of it (or was that the effect of Hyde-Nayak?).

7. A Shot In The Dark
Peter, Dunham and the other FBI agent can’t find an on/off switch or a plug or a circuit breaker between the three of them? So the next logical step is shooting the server?

It’s the reverse of last week. This time, I found the science acceptable, but the story tepid — so they cancel out and the clock stays at 11:55

A list of all previous Fringe reviews is available here.

Tags: television medicine fringe sleep rem hacker adrenalin

Elasti-Girl is taken over by Mento, grown as tall as her powers allow, and then used as conduit for Mento’s psychic powers. The results aren’t pretty for the locals, or for Elasti-Girl.

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed elasti-girl mento doom patrol

A low scoring week, with the high score of 5 point for the episode. Bubbarum, Dana, Jamie II, jwsellers, Robb, and Theta Sigma all scored 5 points.

Overall, TRad remains in the lead with 23 points. Alex Davis stays in second with 19 points, but is now joined by Theta Sigma. Kevin Lighton drops to fourth with his 18 points and Elizabeth drops to fifth with 15.

Click here to see the full scoreboard.

The medical mystery was intriguing on this week’s House, but the medicine was shaky from the beginning, resulting in a rather pedestrian solution. Plenty of so-so soap opera, if you like that sort of thing.

The patient this week is Donny, a police officer with a deathwish. His father, grandfather, and great-grandfather all died at age 40 due to a sudden heart problem. He is convinced that he is going to die at forty as well, so he has started to take crazy chances at work, certain that he will be dead soon enough anyway. In his latest escapade, he fell 30 feet trying to jump from roof to roof after a parkour-ing thief and ended up with a concussion, a couple of broken bones, and a punctured lung. When Cameron hears about his family heart history she admits him for evaluation, to the dismay of House who thinks Donny’s family history nothing more than a coincidence.

The initial differential diagnosis for Donny, focusing on a suspected genetic heart condition, includes Marfan syndrome (an inherited disease of the connective tissue that can affect the aorta and heart valves), Brugada syndrome (an inherited abnormal heart rhythm), and familial hypercholesterolemia (an inherited condition that results in very high cholesterol and early heart attacks). Foreman orders some vague “genetic testing” in addition to an EKG, cardiac catheterization, and echocardiogram. All of the initial tests are normal, so Foreman and team proceed to run further genetic testing on the conveniently available remains of the patient’s father, grandfather, and great-grandfather. It is also discovered that Donny has a son he didn’t know about, so DNA is collected from him as well. Once again, all the tests are negative.

House decides it is time to send Donny home as there is no evidence of any disease. He and Chase tell the patient that he has the very rare (and completely fictional) condition known as Ortoli Syndrome, and that it can be successfully treated with the (fictional) drug Nabasynth. They give him a few breath mints as a placebo and send him on his way. Only it doesn’t work out so well. Donny collapses, dead, four hours later in the laundry room at his apartment complex.

Foreman has Donny’s body moved to Princeton Plainsboro so they can perform the postmortem. As he and House begin the autopsy, starting the Y incision, they notice the body is bleeding, which shouldn’t be happening in a corpse that old. Suddenly, Donny sits up and screams. It turns out he wasn’t dead after all — and no one noticed. He is readmitted to the hospital, and after a brief period of lucidity, becomes essentially unresponsive with a dangerously low blood pressure (though this is forgotten soon enough and he is awake for the rest of episode). The new differential diagnosis is tetrodotoxin exposure (the toxin from the fugu, of pufferfish), sick sinus syndrome (a condition where the heart’s natural pacemaker isn’t working right), or a sinoatrial block (another abnormal heart rhythm). House suggests the underlying problem may not be in the heart at all and recommends the team look elsewhere. Chase proposes some sort of metabolic disturbance and Foreman suggests an autoimmune disease (actually he suggests that the family suffers a “pre-disposition to an autoimmune disease”, but clearly they all had more than a mere disposition). He suggests anti-Ro antibodies (a marker for autoimmune disease) which can lead to heartblock. House concurs and Donny is started on steroids.

There is no improvement, in fact, Donny begins to complain of a severe headache that later becomes jaw pain and then a severe tooth pain. He finds a heavy surgical clamp, conveniently left in the room, and pulls his own tooth out. The team has the tooth evaluated by a dentist (using a specialist, for once) and it is normal. They now decide that Donny must have bone cancer with paraneoplastic syndrome. The inheritance is explained by Li Fraumeni syndrome (an inherited condition where patients have a high chance of developing cancer at an early age), which makes people more likely to develop bone cancer. A gamma scan (a bone scan to look for cancer) is performed but is normal — there is no bone cancer.

House now decides that the condition is a nerve problem and diagnoses Donny with hereditary sensory autonomic neuropathy, type I (an inherited degenerative nerve disorder). He is started on carbamazepine (an anti-seizure drug that can provide partial relief of pain in HSAN1). Almost immediately after starting the drug, Donny loses bowel control, so the team decides they once again have the wrong diagnosis. Autoimmune is suggested once more, but shot down. Wilson’s disease (an inherited disease of copper metabolism) is also suggested, but House notes Donny’s liver functions are normal. The counter suggestion is that his liver is so bad, the labs look normal, so they decide to go ahead and start him on the treatment for Wilson’s disease, penicillamine (rather than, you know, actually testing the liver). Later, while bantering with Cuddy, House has his Eureka! moment and deduces that Donny has a berry aneurysm slowly growing in the brain in just the right place to press against the part of the brain responsible for the heart. Some quick brain surgery and both Donny and his son survive to live a full life.

The medicine had some problems this week. As usual, major complaints are in red, minor in blue, nit-picking in green:

Berry aneurysms can be inherited, but 5 generations of patients with an aneurysm at the identical location in the brain — out of all the arteries in the brain — growing at an identical rate. If you buy that, I have some oceanfront property to sell you in Arizona.
Are the cardiac centers and tooth pain centers even near each other in the brain?

Cardiac catheterizations can have serious complications and they’re not undertaken lightly. I doubt any self respecting cardiologist — at least one who wants to keep her malpractice insurance rates somewhat affordable — would perform a cath on a healthy forty year old with no cardiac symptoms. EKG and Echocardiogram are probably overkill too, but at least they’re not invasive.

Bone Marrow DNA is “more pure?” DNA is DNA — it’s the same whatever cell you take it from. If the blood isn’t “pure enough” surely there are easier — and less painful — ways to get a sample than a bone marrow biopsy.

So this week, in addition to being the team leader and a neurologist (who missed an intracranial aneurysm — the bread and butter of his profession), Foreman is:
A pathologist
A cardiologist
A radiologist
A geneticist.

Sequencing the cardiac sodium channel, in a hospital lab, in a day. Right. See me about that property in Arizona. Even with modern equipment, gene sequencing is tricky, time consuming, and a specialized skill.

HSAN1 doesn’t fit the case at all.

For once, they don’t get a brain scan, and where is the solution? The brain.

At least run some simple tests before declaring it to be Wilson’s Disease.

Verbatim from my wife: “If I were House, I would just walk around the hospital having random conversations with people until I have my Eureka! moment and solve the case.”

I thought the medical mystery was very good this week, but the initial presentation and the Lazarus-like return; I give it an A-. The final solution was pedestrian, an incredible stretch of coincidence, and didn’t really fit all that well. I give it a D. The medicine overall was barely okay — not good, but not horribly bad — like a car accident where the car isn’t a total loss — and earns a C-. The soap opera was plentiful, but nothing spectacular. For the second week in a row, it earns a C.

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

Buzzy is back, along with his girlfriend Susie and his macrocephalic friend Wolfie in this comic book public service ad. As usual, Wolfie is up to no good — though this time it’s his driving ability that is in question rather than his personal skills.

Knowing Wolfie as well as Buzzy does, why would he think getting in a car with him would be a good idea? Especially since seat belts weren’t a standard feature back in 1953.

This PSA is found in DC comics from September 1953. As with virtually all Buzzy PSAs, this page is written by Jack Schiff with art by Win Mortimer.

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Tags: comics psa buzzy wolfie jack schiff win mortimer

In the closing panels of Red Robin #4, Tim Drake is stabbed in the abdomen with a sword by the villainous Widower. In the next issue, it is revealed that his injury required the removal of his spleen.

Found in the upper left aspect of the abdominal cavity, the spleen is roughly the size of a grapefruit and serves several important functions: It removes old and damaged blood cells from the circulation, as well as removing harmful bacteria. It assists the immune system by acting as a large lymph node. It stores extra blood to act as an emergency reserve in case of severe blood loss.

Both blunt and penetrating abdominal trauma can injure the spleen. Penetrating trauma can lead to splenic lacerations. Blunt trauma can rupture it. Unfortunately, the spleen is very difficult to repair — it was once described to me as having the consistency of a sopping, water-logged sponge. Imagine trying to sew that back together. Often the only treatment for a severely damage spleen is splenectomy (removal of the spleen), leaving the patient asplenic (without a spleen).

The main concern in people lacking a spleen is an increased risk of infection. This is not just a slight increase in risk, but a significant increase in the risk of serious infections. In the worst case scenario, there is a condition known as OPSI (overwhelming post splenectomy infection) that can be fatal within just a few hours.

Asplenic individuals are susceptible to a wide variety of germs, but the three most concerning are:

1. Bacteria that have a thick protective capsule. These bacteria include pneumoccocus (a cause of pneumonia and other infections), meningococcus (a cause of meningitis), and Haemophilus influenzae (another cause of meningitis, among other nasty infections).

2. Capnocytophaga canimorsus, a bacteria found in dog bites.

3. Parasites that like to hide within red blood cells (malaria is the main one, but also babesiosis and ehrlichiosis, rare tick-borne infections).

Asplenic individuals need to be aggressively immunized against the riskiest bacteria. They will require the pneumococcus, meningococcus, and Haemophilus influenza vaccines. The pneumoccocal vaccine may need to be repeated every 5 years. Additionally, pediatric patients who lose their spleen need to be started on daily broad spectrum antibiotics for the next 2-5 years. Those who are considered particularly high risk for infection may need daily antibiotics for the rest of their life.

Magneto lands on the X-Men’s island Utopia, but Professor Xavier is not particularly happy about it and lashes out.

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed x-men magneto xavier

It’s time for three more case studies to determine if you’d be a good doctor in a super-hero world. So put on your thinking caps and your diagnostic head mirrors and see if you can make the correct diagnosis.

The previous case studies and a bit more an explanation can be found at Dr. Scott’s Case Studies of Comic Book Medicine

With Halloween just around the corner, I thought it was the perfect time for this public service ad featuring Binky and his giant-bowtie-wearing brother Allergy (and yes, he wears his bowtie even in costume).

I’ve mentioned how often these PSAs featured pro-United Nations themes, and this is a perfect example focusing on the United Nation’s Children Fund — better known as UNICEF. This is the third DC PSA featuring UNICEF (one, two), and here’s a bonus Casper PSA thrown in for free.

This PSA is found in DC comics from December 1957. Jack Schiff, as usual, wrote this PSA, with Ruben Moreira on art. I scanned this in from a copy of Adventure Comics #243 (which features “The Super-Toys From Krypton,” where Superboy’s childhood toys are sent to Earth. Is there anything Jor-El didn’t send from Krypton — other than more people he could have saved, I mean?) There is also a black and white version that can be found in some comics (Action Comics #235, for instance).

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Tags: comics psa halloween unicef binky allergy jack schiff ruben moreira

Posting resumes tomorrow with a look at vampires, werewolves, and porphyria (see the recent Batman annuals and this week’s Castle)

The synthesis of heme (an important part of hemoglobin and red blood cells) is a complicated process requiring eight different enzymes. If any one of these enzymes is not working correctly, then a chemical known as porphyrin builds up and the person is said to have porphyria. There are several different types of porphyria depending on which enzyme isn’t working correctly. Generally, the porphyrias can be grouped into two classes: the acute (or hepatic) porphyrias, and the cutaneous (or erythropoetic) porphyrias.

The acute porphyrias cause severe abdominal pain as well as neurological and psychological symptoms. Some of them have cutaneous (skin) symptoms as well.

The cutaneous porphyrias, as the name suggests, have primarily skin symptoms. Photosensitivity — a painful rash when exposed to light — is a common problem.

In the late seventies and early eighties, several papers and a book or two were published suggesting that porphyria was the basis for vampire and werewolf legends. There is a certain undeniable logic behind the idea. People with porphyria do not venture out in the daylight, which explains the sunlight aversion of vampires (and werewolves, to a lesser extent). The disease can cause a thinning of the lips and gums, exposing more of the teeth, giving the individual a more bestial appearance. Historically, porphyria was treated by having the patient drink animal blood. Additionally, increased hair growth can be seen in some cases of porphyria and the psychiatric symptoms can lead to strange behaviors and increased violence.

It’s an interesting hypothesis, but I’m skeptical. I’m certain that people unfortunate enough to have porphyria were accused of being vampires or werewolves, but I don’t buy the idea that the entire legend is based on the disease. The theory seems to pick and choose the symptoms of different porphyrias to support the idea, creating a hodge-podge disease that doesn’t actually exist in nature (or if it does, would be extremely, extremely rare). Drinking animal blood does not equate to a blood lust — people with porphyria may understand that blood helps their symptoms, but they don’t actually crave it. The theory also describes the modern depiction of vampires — which is quite different from the how our ancestors understood them. For example, the vampire’s violent aversion to sunlight — a main part of the porphyria link — is a twentieth century embellishment to the vampire.

I’m not alone in my views as the majority of the scientific and medical community has dropped the theory (and I’m sure most have even better reasons than the ones I mentioned.) This hasn’t stopped the “porphyria = vampirism” link from appearing in pop culture over the past several decades. I’m pretty sure I remember it showing up as a side plot in an episode of St Elsewhere in the ’80s. More recently, the idea has shown up in the Batman and Detective Comics annuals as well as this week’s episode of Castle.

In the back-up story in the Batman and Detective annuals, the Gotham City Blood Bank is vandalized and robbed, and there is also an attempted murder or two. The villain — or is it villains? — is revealed to be someone with porphyria who believes that they are a vampire.

In one scene, some blood found at the crime scene is sent off to the lab and is returned with a diagnosis of porphyria.
Here’s my annotated version of that scene:

1. DNA testing — DNA and genetic testing is one of the best ways to diagnose porphyria. However, it’s a specialized test that is only run by certain labs and it takes more than just a day or two to get results.

2. There’s been DNA testing, but they still refer to it by the general term “acute hepatic porphyria” rather than which specific porphyria it is. That’s the point of the DNA testing: to pinpoint the exact enzyme deficiency.

3. I don’t think there’s any doubt where the information from this first paragraph came from, and it’s a nice accurate paragraph. [link fixed]

4. The second paragraph is a mess though, referring to a largely abandoned theory as if it were fact. The inaccurate “blood craving” is mentioned. And what is “pale pallor?” By definition, someone with pallor is pale.

I will point out that for the most part the writer makes it clear that it is the villain who believes in the porphyria/vampirism link — and other than the lab report shown above — does not seem to endorse the connection herself.

In Castle, an insane individual who believes himself to be a vampire screams out in flames and starts to smoke when exposed to sunlight. This is later explained away as porphyria.

Now, sunlight can be painful to people with severe cutaneous porphyria, but the skin rash (blisters, usually) take several minutes of exposure to develop — and that’s in the most severe case. The skin never smokes though, that’s simply ridiculous, even for Castle.