Polite Dissent

scene from Secret Six #25 (Simone, Calafiore)

Lady Vic, the cornea overlies the pupil, so it would be impossible to hit the pupil without also hitting the cornea.

scene from X-Men Legacy #235

The Stepford Cuckoos learn the hard way that Cerebra has been sabotaged by Bastion’s group in this scene from the Second Coming crossover.

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed stepford cuckoos x-men

Something is clearly wrong with Dr Superhero, in this scene from Awesome Hospital — though at least he does seem to be wearing his head mirror more or less correctly. I like the way all his mini-clones (a reference to Superman #125, I suspect) are wearing head mirrors too.

And if you’re not reading Awesome Hospital every Tuesday and Thursday, what’s wrong with you?

Honestly, there comes a point where any further resuscitation is pointless. The longer the heart is stopped, the harder it is to get working again. Plus, in the several hours they’ve worked to resuscitate this patient, noxious chemicals have built up in his system causing severe organ damage and muscle breakdown (rigor mortis, for example).

Scene from Grimms’s Ghost Stories #6. Yes, I know this is from a horror comic — where the science is even worse than super-hero comics — but we already have a problem in this country with too many people having unrealistic views of resuscitation and end of life care, expecting miracles from medicine and/or god. The end result is the unnecessary prolongation of the suffering of patients with nothing to show for it. I refuse to encourage this.

Plus it seems they’re massaging his heart through his liver.

With today being Labor Day, I thought it would be the perfect time to feature a comic book public service ad about work. The benefits of teenagers holding a job was actually a fairly common PSA theme as demonstrated by Buzzy and Wolfie twice before in Work Can Be Fun! and The Key to Success! Sadly, this PSA lacks both Buzzy’s constant lecturing and Wolfie’s luckless conniving, featuring instead two generic PSA characters, Steve (the good one) and Walt (the lazy one).

Click on the image for the full ad

I’ve noticed another pattern to these PSAs. Spending a “do nothing day” is bad thing. Walt, the foil, shows that here, and past teenage PSAs always seem to have a lazy guy who ends up sad and depressed because he didn’t work hard like everyone else. Now, a work ethic is a good thing — but so is knowing how to relax. Poor Steve here with his Type A personality is going to work himself into a heart attack and an early grave if he’s not careful.

This PSA was published in August 1957. Like all DC PSAs, it was written by Jack Schiff. Ruben Moreira provided the art.

More PSAs

Tags: comics psa work vacation jack schiff ruben moreira

I’ve talked about decibels before, but I think Superboy’s efforts here deserve another discussion.

To start with, here are a few key points about decibels:
Decibels are abbreviated dB. Since I’m lazy, I’m going to use the abbreviation.
Decibels use a logarithmic scale. So a value of 140dB is ten times more powerful than a value of 130dB and 100 times more powerful than a value of 120dB (and 100 times weaker than a value of 160dB). This same value of 140dB is a trillion times more powerful than a value of 20dB.
A whisper is 30dB, normal conversation is 60-70dB. A loud rock concert is 120db, being close to a jet engine is 140dB.
Sustained exposure of 90-95dB can result in hearing loss. Short term exposure, even once, at 140dB can cause hearing loss.
Sounds louder than 120dB cause pain. Higher than 140-150dB can rupture the eardrums.d
194dB is the loudest non-distorted sound possible, above this level, sound waves act like shock waves.
200db Being at the epicenter of a Richter 1.0 earthquake — also human death from shock wave.
220dB Saturn V Rocket launch, 230dB is equal to being at the epicenter of a Richter 4.0 earthquake, 240dB is the level from an F5 tornado, and 257dB are produced by 1 megaton nuclear bomb

So Superboy’s bomb that “only” produces 5000dB is 10⁴⁷⁵ more powerful than a 1 megaton nuclear bomb, 10⁴⁷⁸ more powerful than a Saturn V rocket, and 10⁴⁸⁰ times what is required to kill a person. Oops.

Of course, it gets worse from there as Superboy and his friend go on to create a sound of 1,000,000 decibels. I don’t even want to think about the math there.

Are you as good a doctor as Reed Richards? Doctor Mid-Nite? Or (god forbid) Henry McCoy?
Now’s your chance to find out. Here are four medical case studies taken from actual comic books.
How many of them can you correctly diagnose?

For more case studies, visit Dr. Scott’s Case Studies of Comic Book Medicine

scene from X-Men Origins: Emma Frost

Most teenagers just had acne, a changing voice, and self esteem issues. Emma Frost had all that, and psychic nosebleeds too.

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed emma frost x-men

Season Seven of House starts in one week, on September 20th, 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:

Make a list of ten conditions or diseases you think will show up on HOUSE. Be as specific as possible: no categories (like “cancer” or “autoimmune disease”), and no overly broad descriptions (“liver failure” or “cardiac arrest”, for instance). The list you make will last the remainder of the season — no addition, subtractions, or swaps. Put your list in the comments section.

Each week, your list will be compared against the show. Scoring is as follows:

1 point for a brief mention or one-liner.
3 points if the team actually tests for the condition.
3 points if your diagnosis is featured in a clinic scene (or other side plot).
5 points if the team treats the condition (or supposed condition).
12 points if it’s actually the correct final answer (or one of the answers) of the episode.
Please note: If your diagnosis is close, but not specific enough (for example “meningitis” when the team tests for “viral meningitis”) you will earn 1/3 the points.

Scores will be collated each week and a running total will be kept. Scores will be posted as soon as possible.

To play the full season, your list must be posted in the comments section by 7pm (Central time) September 20th — 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.

To get things started, here is my list of ten predicted diagnoses for the upcoming season:

Here’s another of DC Comics’ public service ads from the 1950s reminding us how lucky we are to be 1) getting an education, and 2) American.

It features several common themes in PSAs from this era:
Superman whisking children off to the far corners of the globe without any consent or permission. [1][2][3]
A subtle (well, not that subtle, really) put down of other cultures and countries. [1][2][3]

Click on the image for the full ad

This PSA was published in DC Comics from October 1950. Jack Schiff provided the script, and Win Mortimer gave us the art.

More PSAs

Tags: comics psa superman school jack schiff win mortimer

Supergirl #55 “Fakeouts”
Sterling Gates, writer
Jamal Igle, penciller

A strong effort here by Gates and Igle. After Gangbuster gets his hand crushed by Bizarro Supergirl, the real Supergirl uses her x-ray vision to (correctly) the injury suffered.

“She broke two of your metacarpals”

The metacarpals are the main bones of the palm; there is one for each finger, including the thumb.

In this case, Gangbuster has suffered closed¹ transverse² comminuted³ fractures of the second and third metacarpal shafts. We can see that the bones are out of place (”displaced“), but since we’re only getting a two-dimensional view, we don’t know how out of place they are in the third-dimension (”angulated“).

The usual treatment for metacarpal fractures like these:
1. Reduction — Get the bones back into place. For metacarpal fractures, a closed reduction⁴ is usually used. If the fracture is unstable, it may require pins be placed surgically to hold the bone together properly. As for those little bone chips, unless they are causing problems or otherwise interfering with the hand’s function, they will probably be left alone.
2. Immobilization — Once the bones are back in place, the patient will be splinted for a couple of weeks, usually around four to six. You don’t want to splint for too long, or it can be difficult to get the full range of motion back in the fingers and wrist. Aggressive physical therapy will probably also be required.

Notes:
1. Closed Fracture: The bone is broken, but the skin overlying it remains intact (as opposed to an open fracture, where the skin over the break is torn — and broken bones may be poking out).
2. Transverse Fracture: The break is side-to-side across the bone, rather than oblique or spiral.
3. Comminuted Fracture: The bones are broken into more than two pieces.
4. Closed Reduction: A non-surgical intervention where the broken bones are physically manipulated back into their proper locations. A generous amount of anesthesia is still used because it is absolutely no fun for the patient.

For once, Max Lord is on the receiving end of someone’s psychic powers rather than the giving end. In this scene from Justice League Europe #17, Lord’s mind is overwhelmed by the power of the sorcerer Dreamslayer.

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed maxwell lord dreamslayer

Not an auspicious start to the season with only three players scoring any points, but then again, the medicine was clearly an afterthought in this episode of House. Next week, I expect things to get into full swing.

As of Week 1, Ron leads with 5 points. tina and Tv Miller are in second with 1 point. Everyone else is dead last (or tied for fourth, depending on your point of view) with zero points.

Click here to see the full scoreboard.

Certainly not a bad episode, but not a terribly exciting episode medically. Most of the time was spent setting the new Cuddy/House status quo, for better or for worse. On the other hand, the episode proved what I have always suspected: stoned neurosurgeons are comedy gold.

A transition episode tonight, taking up shortly after last season’s finale. As expected, a large part of the episode focused on House and Cuddy who are alternately talking about their relationship, pointedly not talking about their relationship, having sex, and playing Boggle. They are also doing their best to avoid Wilson.

Meanwhile, back at the hospital, a crisis is brewing. Dr. Richardson, the only neurosurgeon currently on staff has taken suddenly ill and gone home. The difficulty arises because with no neurosurgeon available at the hospital, Princeton-Plainsboro will lose its accreditation as a Level I Trauma Center and have to close its ER and ICU. With House and Cuddy otherwise occupied, House’s team is forced to step in to keep the hospital running. Chase offers to act as neurosurgeon, but Cuddy’s new assistant shoots him down, pointing out that while he’s been trained as a neurosurgeon, he is not board certified as one. When no other local neurosurgeons can be found, Chase and Thirteen head over to Dr. Richardson’s house to drag him back to the hospital. They find him sitting on the floor next to the toilet, extremely nauseated and ready to throw up. He tells them that he has food poisoning from eating bad sushi. However, when the team learns that his symptoms have persisted despite taking two anti-nausea medications (promethazine, aka Phenergan, and trimethobenzamide, aka Tigan), they suspect something else may be going on. They treat him with ondansetron (Zofran, a stronger anti-nausea medication) and prostaglandins and a short time later his nausea is gone and he feels great…unfortunately, he’s also completely stoned. They figure the medications they gave him must have made him high, so they shuffle him off to the hospital for further treatment. They aggressively hydrate the neurosurgeon and run labs, suspicious of hepatitis or peptic ulcer disease, but nothing turns up and he is not improving When the inspector from Health Services comes to evaluate the hospital, they try to pretend Dr. Richardson is fine, but he takes off all his clothes in front of the inspector and walks down the hall virtually naked — giving the investigator no choice but to strip their accreditation.

The team decides that Dr. Richardson has remained high for too long for it to be one of the drugs they gave him, so it must be something else. He admits sneaking out of the hospital one night when he was supposed to be on call and going to a seafood festival where he ate all kinds of seafood. Thirteen deduces that he must have eaten toad eggs, which, according to her, can cause nausea and euphoria. Luckily, she says, the treatment is fast and easy, and sure enough, Dr. Richardson is back on his feet in time for the hospital to keep their accreditation.

Finally, in other news, Thirteen is leaving the hospital, but she is intentionally hiding from the rest of the team where she’s going and why.

Not all that much to comment on medically this week, but here goes:
If Chase graduated from a neurosurgery residency, then he is a neurosurgeon. Granted, he may not be a board-certified neurosurgeon, but he is still a neurosurgeon.

If a hospital loses it’s Level I Trauma Sstatus due to lack of neurosurgery resources, then it is logical to divert neurosurgery-requiring patients to other ERs and move patients from the Neuro ICU. There is no reason to shut down the ER and ICU as a whole though.

Nausea is often difficult to treat, even with strong medications, so it’s really no surprise that the patient would be still have symptoms after receiving Phenergan and Tigan. It’s not a cause for panic, or even a sign that something bad is going on.
Phenergan and Tigan both work through the same pathway, if one doesn’t work, it’s doubtful the other one will either.
That being said, rushing to a diagnosis of peptic ulcer disease and hepatitis (especially hepatitis) based on just the symptom of “difficult to treat nausea” is quite a jump.

I’m not sure what medications the team thought were causing Dr. Richardson’s euphoric state. Neither ondansetron or prostaglandins cause anything like that. Phenergan and Tigan can occasionally cause confusion and even hallucinations, but nothing like what he was experiencing. They should have realized something else was going on right away.

There have been a couple of cases reported of nausea associated with eating toad eggs, but these cases also presented with severe cardiac problems. In my (admittedly cursory) examination of the relevant literature, I can find no reported cases of toad eggs causing both nausea and euphoria (and precious little about the latter alone).
There is no miracle cure for toad egg poisoning, which is probably why they never specifically mentioned what this cure was.

Not a medical comment, but I’m very surprised that Cuddy’s daughter wasn’t even mentioned until ¾ of the way through the episode. Did no one notice or care that Cuddy didn’t come home last night?

The medical mystery was weak, but then it was clearly a secondary concern (though probably a tertiary concern, after Thirteen). I give it a C-. The final solution was also weak, and quite a jump in logic. I give it a D. Overall, the medicine was poor this episode, earning a C-, but that’s really no surprise as no one really thought this episode would be about medicine. The soap opera was good, but a touch overly melodramatic at places for my taste: A-.

A list of all prior House reviews

This week’s House Challenge scores have been posted

Public service ad favorite Allergy is back — along with his enormous bow tie — to teach us how to act like responsible adults. Or at least responsible adults with unusual taste in neckwear. Sure, his “more popular” brother Binky shows up too, but only at the very end.

Click on the image for the full ad

According to this PSA, two of the most dangerous things in the world are baseball and baby brothers. I really can’t disagree.

I like how Binky gets top billing though he only appears in the final panel, well after Allergy and Billy have decided on their own to do the right thing. Way to hog their glory, Binky.

As this is a black and white PSA printed on the inside cover of the comic, all the copies I have show some bleed-through from the image on the front cover. This is the best version I could find.

This PSA was published in July 1954. Jack Schiff, as usual for the DC Comics PSAs of this era, provided the script while Win Mortimer provided the art.

More PSAs

Tags: comics psa alelrgy binky jack schiff win mortimer

scene from Superman #75 (March-April 1952)

This is one of your Silver Age comics with the extremely complicated and contrived villainous plots. It all starts when the Prankster gets out of prison and opens a “School of Humor.” His plan is to have his students unwittingly pull pranks and practical jokes that allow him and his gang to easily get away with crimes. For instance, he has one of his students pretend to jump off a building (while wearing a hidden bungee cord), drawing the police away from a nearby jewelry store he’s going to rob. Another student sets off a smoke bomb in a bank, allowing his gang to plunder the vaults without anyone noticing.

This isn’t enough for the Prankster, however. He needs something to distract Superman, so he sets his sights on Lois Lane. He wants Lois to enroll in his school, but everyone knows that Lois Lane (at least the Silver Age Lois Lane) doesn’t have a sense of humor. So to give her a sense of humor, he exposes her to his newly developed Super-Laughing Gas that gives her a “pixie sense of humor” (that’s the exact phrase the comic uses — more than once — during the story). The newly humorous Lois enrolls in the School of Humor and starts pulling all sorts of lame jokes on Superman that keep him distracted (for example: she tells him that the drawbridge operator is having trouble with his bridge and Superman rushes off to help — only it’s his dental bridge she’s talking about). Of course, the joke’s on the Prankster in the end as Superman catches on to his plan, captures him, and cures Lois of her pixie sense of humor.

Despite all this preoccupation with the Prankster’s School of Humor, the ultimate part of his plan doesn’t depend on anything humorous at all — instead he tells the court that Superman can’t charge him with a crime unless Superman gives his true name. The court agrees, so Superman has to give his real name or let the Prankster free. Superman ponders a while before giving his name as Jor-El 2, which the court accepts and the Prankster is charged.

This makes me wonder:
1) why not Kal-El, surely he used that name before 1952?
2) Did Bob Ingersoll’s “The Law is a Ass” column ever address this issue?

A good start the season on Fringe tonight. A slight technobabble stumble at the end, but otherwise an excellent episode.

The Plot: The episode opens with Olivia, strapped to a chair, being psychoanalyzed. Though this is the Olivia from our world, the doctor is trying to convince her that she is the Olivia from the alternate universe. As the scene progresses, we learn that Walternate has been injecting her with something to give her the alternate-Olivia’s memories to convince her that she is that Olivia. Later that night, when she is brought to the lab for another injection, she feigns being ill, attacks the scientists and guards, and then escapes the compound. She discovers she’s being held at Liberty Island, but decides to risk the swim to Manhattan (or more correctly, since this is the alternate universe, “Manhatan”).

Agent Broyles (actually, “Colonel” Broyles, in the other universe), Agent Francis, and Agent Lincoln all join the search to find Olivia. Of them, only Broyles knows the truth. Agents Francis and Lincoln believe that she is alternate-Olivia who took a blow to the head and suffered a psychotic break.

Olivia makes it to the city, and once there, she hails a cab and has Henry, the driver, take her to get some clothes and then to the Opera House where the Fringe team crossed between universes last season. Unfortunately, she arrives just in time to see the Opera House sealed in amber jello, so that escape route is lost to her. She returns to the cab and tells Henry to drive her to Massive Dynamic, figuring they would have a way for her to cross universes. However, when they stop for gas she is confronted by Agent Lincoln, who still believes she is the alternate Olivia. She disarms him then locks him in the gas station restroom. Agent Francis aims a gun at her as she and Henry are escaping in the cab. She points her gun back at him, but can’t bring herself to pull the trigger on Charlie — instead, she shoots the valve off the propane tank behind him, causing it to explode, and covering their escape.

Walternate and Colonel Broyles watch her escape with interest. Noting the difficult shot she made, they take it to mean that alternate-Olivia’s memories are worming their way into Olivia’s brain because alternate-Olivia is an Olympic level marksman.

When Olivia and Henry arrive at the Massive Dynamic address she is shocked to discover it is nothing more than a park as Massive Dynamic does not exist in the alternate universe. She is ready to give up when an address pops in her head — an address to a safehouse. Henry drives her there and she tells him to go back to his family. Olivia enters the House and encounters alternate-Olivia’s mother. Olivia protests that she is not alternate-Olivia, but a flood of alternate-Olivia’s memories spring up. By the time Charlie arrives to take her back to the city, Olivia is firmly convinced that she is alternate-Olivia.

At the end of the episode, we get a brief glimpse of life back in our universe. Peter is undergoing a debriefing about his experiences in the other universe, then joins Walter and alternate-Olivia, little realizing she is not the real Olivia.

1. Vive la différence
I liked the fact that smash Broadway hit in the alternate universe was Dogs — as opposed to Cats in ours.
Plus the JFK, Statue of Liberty, and Martin Luther King changes.

2. Wouldn’t It Be Loverly
His name is really Henry Higgins — as in Pygmalion, or if you prefer, My Fair Lady.

3. Typhus Mary
Typhus is an arthropod-borne disease — i.e. carried by fleas, ticks, or lice. While it is prevalent in many developing nations, it is not common in the United States. Actually, “typhus” refers a few distinct but similar diseases, none of which are common in the US. Fifteen cases of epidemic typhus have been linked to flying squirrels (or the fleas on them, actually), and a few cases of murine typhus occur each year in California and Texas. It is not a big city disease.
There is no vaccine against typhus — in the real world, anyway.
Typhus is completely different than typhoid, for which there is a vaccine.

4. Almost
This episode was going so well until they tried to explain how the memory serum worked. They should have just left it a mystery rather than try to explain it away. Memory B lymphocytes don’t carry actual memories per se. Instead, they carry specific antigens (germs, allergens) that we’ve been exposed to in the past, so that if we’re ever exposed again, the body can mount a rapid immune response and start churning out antibodies quickly. Despite the name, they don’t play a role in a person’s memory or recall – their role is in the immune system.
White blood cells, such as B lympocytes, can’t cross the blood brain barrier — even under the influence of adrenalin. If they are crossing the blood brain barrier, then something very wrong and very nasty is going on; something such as a meningitis infection.

Overall, a very good episode. I was dismayed by the bad science at the very end, but the episode was still good enough to bring the Doomsday clock back to 11:55

Tags: television fringe alternate universe olivia memories lymphocytes

scene from X-Men Origins: Emma Frost

Another psychic nosebleed, courtesy of a teenaged Emma Frost.

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed emma frost x-men

Why, I bet that would make a pretty good plot for a movie!

(Scene from Superman #75, “The Man Who Stole Memories”)

A better week for players, thanks mostly to amyloidosis — with some help from tuberculosis, sarcoidosis, and zinc/heavy metal poisoning. Several players came oh so close to the correct final diagnosis, but the fact that it was sickle cell trait tripped them up.

Chaya had the high score this week with 10 points, followed by Eli with 9. A whole bunch of people (too many to list here) earned 7 points.

Overall, it looks very similar with Chaya in first with 10 points, Eli in second with 9 points, and too-many-people-to-list tied for third with 7 points.

Click here to see the full scoreboard.

The medicine was illogical with a final diagnosis that was unbelievable, but this was never an episode about the medicine — it was all a set-up to force the choice at the end.

On the casting side, It was nice to see Flo (from the Progressive ads) in a serious role, and I kept expecting Della to say “whatcha doin’?” (you know, Isabella from Phineas and Ferb, right? I can’t be the only one here who watches it).

Della is a 14 year old tomboy who is performing at a skateboarding charity exposition when she suddenly becomes dizzy then collapses. The EMTs who treated her at the scene reported that her heart had stopped. She is admitted to Princteon-Plainsboro for evaluation of a heart arrhythmia. The initial studies, including EKG, echocardiogram, and head CT, are all negative. The team’s starting differential diagnosis includes a delayed form of muscular dystrophy (since Della’s brother has severe congenital muscular dystrophy) or long QT syndrome (an inherited disorder that can lead to a fatal arrhythmia). The latter seems the most likely, so House wants the team to scare Della in an attempt kick off the arrhythmia — which might also have the unfortunate potential of scaring her to death. Cuddy steps in and wants House to perform an angiogram and electrophysiological studies instead. House accedes, but as Foreman and Taub are prepping her for the studies, they learn that Della is oliguric — she has not produced any urine for the past twelve hours, despite getting copious amounts of IV fluid. Foreman diagnoses this as kidney failure. The new differential diagnosis consists of Fabry’s Disease (an inherited condition where lipids are not metabolized correctly and build up in the body) and amyloidosis. House thinks amyloidosis fits the best, so has the team get her ready for a bone marrow transplant from her brother (who was coincidentally determined, off panel, to be a match).

Della refuses treatment. She does not want any pain or any risk of harm to come to her brother. As she is arguing with the team, she begins to cough up blood. Taub diagnoses a hemothorax. House reports to Cuddy that Della is bleeding out of her lung, and he want to clot it off with a special foam. She agrees to the procedure, but House decides to go ahead with the not-as-succesful but less-risky option of suturing the bleeding vessels in the lungs. Della’s differential diagnosis now consists of sarcoidosis, tuberculosis, or Goodpasture’s Syndrome. Goodpasture’s, a form of autoimmune disease, seems the most likely, so House has Della started on immunosuppresants and plasmapherisis while a kidney biopsy is performed. Unfortunately, when the biopsy comes back it does not show Goodpasture’s but instead shows LAM (lymphangioleiomyomatosis). Della needs a lung transplant.

Luckily, a lung quickly becomes available for transplant, but it starts to fail within an hour of the surgery. To House, this means either the lung was bad (infection), or Della is rejecting the transplant. He is worried that giving her immunosuppressant medication to treat a possible rejection might make an infection worse, but also that giving antibiotics for a supposed infection might make the rejection worse. He chooses to start the immunosuppressant (the steroid methylprednisolone in this case) because if he’s wrong, it will give him more time to correct his mistake. Cuddy disagrees and feels that starting with the steroid is riskier and wants House to start with the antibiotics instead. House folds and the antibiotics are started. When Della starts to get worse despite the antibiotics, the team switches her to the steroids instead. When she still shows no improvement, this means both their possible diagnoses were wrong.

A stray comment by Della’s brother leads House to suspect that she is withholding some symptoms. Begrudgingly, she admits she has been having cold-like symptoms, ear pain, and a sore chest for the past year, since a trip to Denver. This leads House to realize that Della is a carrier of the sickle cell trait (she is a carrier for the sickle cell gene, having one normal hemoglobin gene and one hemoglobin-S gene), and her symptoms are all relatable to this condition. The sickle cell trait also gave her a false positive on the LAM test. It’s unlikely she’ll get a second lung donated for transplant, but House’s team suggests that she would do well with half a lung and a bone marrow transplant from her brother. Unfortunately, this would drastically reduce his already shortened lifespan. The patient is against the idea, as are her parents, and Cuddy. Her brother, however, wants her to go through with the procedure so part of him so he can go on living through her. She agrees. And they all live happily ever after (though much shorter lives).

To head off comments, while the final diagnosis of sickle cell trait is extremely unlikely, it is not impossible. Sickle cell is very, very rare in caucasians, but not unheard of. Sure, it often shows up as anemia on a blood count (especially in symptomatic patients), but not always.
On the other hand, there have definitely been cases of sickle cell crises associated with exercise in people with sickle cell trait.
That being said, I don’t buy that sickle cell would make a false positive LAM test.

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

Hemothorax occurs when there is bleeding into the pleura (the membrane around the lung) which causes the lung to collapse. It is bleeding outsideof the lung. It is completely different from bleeding that occurs within the lung, which is what this patient had.

It is true that immune suppressants can worsen infections, but it’s not true that antibiotics worsen transplant rejection. Antibiotics are a routine part of post-transplant treatment. For example, I have several post-transplant patients, and most have been on a daily antibiotics since their operation.

Electrophysiology studies and angiograms are not used to diagnose long QT syndrome (but then, neither is scaring the patient to death).

If the lung transplant is rejecting almost immediately, then it is hyperacute rejection, which does not respond to immune suppressants.

Oliguria does not automatically indicate kidney failure. There are several other causes of decreased urinary flow, a urinary blockage for instance (though I will admit that renal insufficiency (i.e. kidney failure) is the most likely).
For supposed experts, they don’t pay a lot of attention to the most basic statistics available on ICU patients such as their I/Os (ins and outs).

Fabry’s is an x-linked recessive disease, so it generally does not show up in women.

It would save a lot of time and effort if they waited for a diagnosis before starting treatments. Both the amyloidosis and Goodpasture treatments were started – and these are not benign non-risky treatments – without proof of diagnosis.

Since she’s already had at least one arrhythmic episode, Della is going to be on heart monitors. Heart monitors would cause the alarms in the heart monitoring station to start going off the minute she showed a flatline (which is what unhooking her leads would show). She would have been found long before she made it down the stairs.

I want to make brief mention of a topic that has been bothering me for several seasons: the team’s poor differential diagnosis skills. The team should start with a huge number of diagnoses and slowly narrow it down as new information (labs, tests, symptoms) become available. Each new symptom should have the team crossing off diagnoses, not adding new ones. For example, if Goodpasture’s syndrome explains the kidney, heart, and lung symptoms, then it would also have explained the kidney and heart symptoms, and also just the heart symptoms. It should have been on the list from the start.

The medical mystery was interesting, thought the arrhythmia got lost along the way. I give it a solid B. The final solution was unlikely, and didn’t really do a good job of matching the symptoms or time course. I give it a C-. The medicine was scattershot, another week of jumping from one unlikely diagnosis to the next. The clinic scenes did bring up the score, leading to a final grade of B-. The soap opera was good — both the serious House/Cuddy scenes as well as the hilarious House/Cuddy/Wilson scene. Ii earns a B+.

The review of the previous episode of House
A list of all prior House reviews

House Challenge scores from Week 2 have been posted and can be found here.

This week’s public service ad not only features Binky and Allergy, but the entire Biggs family (and looking at Dad, we can see where Allergy gets his good looks).

Click on the image for the full ad

I’ve got nothing to add to this PSA (other than to point out its casual sexism) since I think it actually makes a good point. Back in elementary school (many, many years ago), one of my teachers told us that the most popular American television show overseas was The Dukes of Hazzard and many of its viewers thought the show was an accurate representation of life in the United States. Even at that young age, the thought frightened me.

Remember what Sartre said: “Hell is other people”.

This PSA can be found in DC comics from October 1952 — this particular copy was scanned in from Action Comics #173. Jack Schiff wrote the script and Win Mortimer handled the art duties.

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Tags: comics psa allergy binky france jack schiff win mortimer

While buying some candy at the drug store, Jimmy Olsen overhears some crooks talking about kidnapping him, hooking him up to a lie detector, and then questioning him until he tells them Superman’s secret identity. Sure, Jimmy doesn’t know Superman’s real identity, but the thugs don’t know that and he’s worried that they’ll try to beat the information out of him. He needs to figure out a way to tell a believable lie.

Jimmy decides the way to beat the crooks at their game is to tell the best and biggest lie ever. Luckily, among the souvenirs Superman has left him from his recent cases is Lie Serum, invented by some unnamed crook to fool the police’s lie detectors. As the name suggests, it’s the opposite of Truth Serum, and whoever drinks will tell nothing but lies until it wears off (how this beats the lie detector isn’t clear — after all, the person is still knowingly telling lies).

The serum works well — too well, actually. Thanks to his lies, Jimmy turns down free ballgame tickets from Lois and a free date with a beautiful actress.

About this time the criminals finally get around to kidnapping Jimmy and hooking him up to the lie detector. When they ask him who Superman is, he tells the biggest whopper yet: Clark Kent is Superman. Who could believe that such a weakling could really be the Man of Steel? The crooks rush over to the Daily Planet to shoot Clark — not to kill him, because they know Superman is invulnerable — but to see if the bullets bounce off thus proving he is Superman. Clark creates a quick smokescreen by igniting some paper on his desk and in the confusion Jimmy is able to disarm and capture the crooks. In the end, Jimmy throws away the Lie Serum claiming that it’s “more trouble than it’s worth — like all lies”.

All Scenes are from “The Super Liar of Metropolis” found in Superman’s Pal Jimmy Olsen #16 (October 1956)

Tags: comics medicine jimmy olsen lie serum superman lie detector

Some good evil from Fauxlivia, but the science, such as it was, was enough to cause hearing loss.

The Plot: Three guys have broken into a family’s house, tied up the family members, and are digging for something in the basement. Under the foundation, they find a strangely marked box. They bicker for a while and then open it – which this being the world of Fringe — was a big mistake. Their eyes roll back, their noses bleed, and they fall into some kind of fugue state before they die. The third crook, who had been upstairs, comes down, sees what has happened, closes the box, picks it up, and runs away. As he leaves, we see that the family are all dead, with filmy eyes and bloody noses, jut like the criminals.

Meanwhile, Fauxlivia meets with Newton (the main non-Walternate villain from Season 2) and we learn that he is working for her now. We also learn the criminals were sent after the box at her request. (I’m going with Fauxlivia, courtesy of io9, rather than the semi-official “Bolivia” because I think Fauxlivia is cleverer. I’m calling Bolivia “semi-official” because I noticed that’s what the closed captioning is using.)

Back at Walter’s lab, Peter and Broyles are discussing the doomsday device Walternate is building to destroy our world. It’s clear that it weighs heavily on Peter’s mind.

The Fringe Team is called to the site of the last night’s burglary. They arrive and examine the dead family and criminals. Peter and Fauxlivia realize that whatever the crooks were after is missing, so there must have been a third thief. Walter notices the nosebleeds are pinker than they should be and suggests it may be because the blood is mixed with spinal fluid. He also believes the victims were in a “vegetative trance” before they died. He takes one of the corpses back to lab and eventually determines that the inner ear has been damaged. He deduces that ultrasonics must have affected the brain to and this is what killed the victims, similar to how music can affect brainwaves (and was the Miami Vice theme he used as his example of rock music?).

Walter and Peter arrive at Massive Dynamic to attend the reading of William Bell’s will. Walter receives an envelope containing a safety deposit key and a note telling him that sometimes he has to “cross the line.”

Fauxlivia has found the apartment of one of the dead criminals. She ransacks it but can find nothing. When Peter arrives, she spins a blithe lie as to why she never called him. Meanwhile, the third criminal has noticed her outside the apartment. He tracks her to her apartment and hands over the box because he thinks she represents the government. It turns out he’s deaf, which is why the box’s ultrasonics did not affect him. Fauxlivia shoots him for his troubles.

Newton takes the box to a subway station and cons a local homeless man into watching it, knowing he’ll open it. Soon enough, the Fringe team is called to the because of several strange deaths. The box can’t be seen, so it must be in one of the tunnels. Peter decides that the box needs to be disarmed, and that he’s the best to do it. Walter has Fauxlivia fire her pistol next to Peter’s ears to deafen him so that he can survive his exposure to the box. Peter is able to find and deactivate the box – he also recognizes that it’s a part of Walternate’s machine. Unbeknownst to him, a subway train is heading his way, but Fauxlivia sprints into the tunnel and saves him just in time.

As the episode ends, Peter is trying to figure out how the ultrasonic generator fits into Walternate’s doomsday machine, Fauxlivia is communicating with her bosses back home, and Walter has opened the safety deposit box to learn that he’s now the sole owner of Massive Dynamic.

1. Beethoven, et. al.
Generally speaking there are two types of deafness and hearing loss. There is conductive hearing loss, where the sound waves are not conducted properly, and sensorineural hearing loss, where the nerves and/or brain are not working properly. It’s a very complex subject that I don’t have the time or expertise to do it justice, so I’m just mentioning it briefly to point out the show (and Walter) somehow managed to be both vague and contradictory.
Ear protection won’t work (so it’s not conductive?).
Eardrums are ruptured by the sound (so it is conductive?)
Deafness, or at least some kind of deafness, is protective.

2. And the Crown Rump Length is 2 Inches
In the Fringe world, ultrasonics seem to have the following effects: vegetative trance (and how can you diagnose it as “vegetative” after the person has died?), filmy eyes, nosebleed, and death.
In the real world, ultrasonics have been known to cause heating of tissue, nausea, headache, and ringing in the ears among other symptoms. It is theorized that too intense an ultrasound exposure could cause death in a human. Here’s a nice chart showing the effects of ultrasound exposure at any given decibel level (borrowed from this site, which has a great deal of information about “ultrasonic sickness”.)

In the Fringe world, ultrasound also affects train electronics.

3. You Spin Me Round Round
Endolymph is the clear fluid in the inner ear, which is located fairly deep in the skull. There’s not all that much of it, so how did it get all the way through the middle ear into the ear canal? For one thing, that indicated the tympanic membrane (ear drum) is ruptured. One would think that since the patients were all sitting or standing upright, the endolymph would drain down the Eustachian tube before making to the ear canal.

4. Sadly Not Psychic
Ultrasonics have been known to cause nasal irritation, so a nosebleed is not out of the realm of possibility. But why the “lighter color?” Was it spinal fluid — as Walter originally suggested — in which case what caused the cribiform plate (the part of the skull between the brain and nose) to rupture? Or were they suggesting it was the endolymph from the inner ear, in which case how did it get all the way to the nose?

5. I’m Attacking the Darkness
The gunshots were a really stupid idea. The resulting deafness was likely caused by cochlear injury (known to be damaged by sudden loud noises such as gunshots or firecrackers) and/or eardrum rupture. Either way, it’s going to last a lot longer than 3 minutes — and in terms of cochlear damage, is likely permanent.
Isn’t shooting two bullets in a relatively small area really stupid? No richochets?

6. Addicted to Love
Now we know where the girls went after Robert Palmer’s video — they work at Massive Dynamic.

7. One, Two, Three, Four, Five, Five, Seven
Broyles refers to the “five” dead bodies at the house — only there were six (two crooks + four family members).

I liked the Fauxlivia versus the (oblivious so far) rest of the team aspects of the story, but the poor science cost it. Even a brain-related nosebleed can’t save this episode from moving the Doomsday Clock one minute close to midnight.

Tags: television fringe ultrasonics deaf fauxlivia