Polite Dissent

Hot Stuff Sizzlers #41
Another good example of the x-ray cover gag. (Though one wonders why his heart is where the stomach should be — unless that’s somebody else’s heart he ate)

This week, I’m going to take a look at one of the back of stories from Sue and Sally Smith: Flying Nurses #49. This story concerns a sixteen year-old girl who has an unrequited crush on her doctor. As for the Flying Nurses, I talked about them back in Nurse Week #2 (and I’m positive we’ll see them again soon).

Friday Nurse Day #4:
Sue and Sally Smith: Flying Nurses #24 “Doctor’s Love”

Sandy is a teenager who has fallen in love with the doctor who saved her life – actually, that’s not quite true as she was hospitalized with a viral infection, nothing truly life threatening. Nevertheless, Sandy has fallen in love with Dr. Ben Langner. She stops by his office every afternoon to see him, but she’s frequently frustrated when he has to leave because of one emergency or another at the hospital.

In order to see more of Dr. Langner, Sandy decides to become a volunteer at the hospital. Her plan works as she now runs into Dr. Langner every day. However, she also finds herself attracted to Dr. Loomis and Dr. Sissonby and even the pudgy middle-aged doctor who never even gets a name in the story. When she tells her parents of her predicament, her mother chuckles and tells her that she’s not really in love with the doctors – it’s the field of medicine she loves.

Sandy realizes that her mother is right and decides to become a nurse. When Dr. Langner hears that she’s going to nursing school, he stops by to congratulate her, and — after she becomes a nurse — they end up getting married (five years later, so it’s not quite so skeevy).

Vitals:

Published: January, 1962 by Charlton Comics

Cover price: 12¢

Time Capsule: The use of G.P. (”General Practitioner”), a phrase which over the past twenty years has been replaced by “Family Practitioner” (a term I prefer as we truly treat the entire family). Also, the idea of primary care doctor performing appendectomies. It may possibly still be performed at remote rural hospitals where there are no other options, but not at the large urban hospital in this comic.

Most progressive moment: Who are we kidding? There’s nothing progressive in this story.

Inexplicable: Dr. Langner thinking he looks good in a purple suit. That only works for the Joker — and maybe the Riddler.

Previous Friday Nurse Days: #1: Three Loves   #2: Fire Storm    #3: Memories of the Past

At a trivia night Friday night then an early 5K run Saturday morning. Will get the full review posted soon as I can, probably later afternoon/early evening Saturday.

An average episode of Fringe — nothing outstanding, but nothing horrible — with a couple of strange choices for plot explanation.

The Plot: Dr. Blake, a prominent scientist receives a package in the mail on his birthday. When he opens it, there is a cloth doll inside. He pulls the string on her back and she laughs and then releases a cloud of blue powder at him. After inhaling the powder, he collapses in excruciating pain, all the bones in his body fracturing and disintegrating. The Fringe Team is called in to investigate. They discover the doll and bring it back to Walter’s lab for analysis. After a bit of investigation Walter learns that it is a biological weapon used to dissolve the victims’s bones.

Olivia and Peter check out post office surveillance and identify who sent the package to the scientist. He turns out to be a decorated former marine. They search his house and find a case of the bioweapon in the basement – but with three canisters missing. One had been used against Dr. Blake, leaving two unaccounted for. The marine shows up and is pursued, but he is hit by a car and ends up in a coma. They track down his ex-wife who tells the team that after getting out of the marines, he had been doing some consultant work on bioweapons. He blamed his wife’s miscarriage on the bioweapon experiments and swore to kill Dr. Blake — who was in charge of the project.

Walter mentions that he has a way to get information from the comatose marine. He mentions Simon, another child in the cortexiphan experiments who was dropped from the project after he developed the unsettling ability to read minds. Olivia, Peter, and Walter track down Simon, and Olivia eventually convinces him to come to the hospital to read the marine’s mind. He is able to pick up certain words and phrases, though much of it seems to be a grocery list.

Broyles calls on Nina Sharp and her contacts to find out more about the bioweapon project the marine was working on. It turns out that three ex-marines worked on “Project Jellyfish” and all three of their wives suffered miscarriages – which they blamed on their work with the project. Meanwhile, a second bioweapon attack has occurred, killing three executives from the defense contractor that ran the bioweapon project. A search of pay records show that in addition to pay, the first marine was given a three acre farm not far from town.

The Fringe Team searches the farm and finds evidence that the two remaining marines are planning to launch a large attack with the remaining bioweapon canister. Thanks to notes conveniently left behind and some of the information gathered by Simon, the team deduces that they are going to target a congressman who was once an army general. The place of attack is a fundraiser at the local art museum. Simon and Olivia arrive at the fundraiser and locate and take out one of the marines, but he doesn’t have the bioweapon on him. They search the crowd and manage to kill the second marine just before he activates the weapon.

The mystery of the week solved, the episode ends on two related vignettes:
Nina realizes that the books on the First People, supposedly written by different writers in different languages, actually were written by Sam, the mysterious bowling alley owner we haven’t seen since last season. He tells Nina the First People machine will destroy one universe and save one universe – it all depends on which Olivia Peter chooses.
Simon hands Olivia a note of what he read from Peter’s mind. It tells her that he still has feelings for Fauxlivia.

1. No Star Trek Novelizations?
William Bell has an interesting choice in books: In the Wake of Chaos; The Second Ring of Power; Gödel, Escher, Bach: An Eternal Golden Braid; an old edition of Cell and Molecular Biology; and finally, one of Dr. Spock’s baby books (clearly a nod to Leonard Nimoy’s best known role).

2. He’s a Genius?
Hey look! I’ve found the delivery device for the unknown bioweapon. We have no idea if our biohazard suits will be effective. Why don’t I pull the trigger again to see what happens? Brilliant idea, Peter.

3. When in Glasgow
The marine is suffering brain swelling — common after a head injury. This has increased the intracranial pressure around the brain, and that in turn is forcing the brain farther down into the skull, causing a herniation. These are particularly nasty and the doctor is right about his poor prognosis.
Still, he’s having some remarkably coherent thoughts for someone whose brain has all but shut down.
Apparently HIPAA doesn’t apply if the Fringe Team wants information.

4. Pathogenicity
What exactly is a DNA Pathogen? Is it a piece of DNA that acts as a pathogen (like certain viruses), or a pathogen that targets DNA? And what does it have to do with causing a miscarriage?
Why not just say the marine developed damage to his DNA during the experiments and this was passed along to his child rather that trying for technobabble?
Seven months is surprisingly late for a complete lack of bones to finally be noticed.

5. Way, Way Off
Despite what Walter says, the vast majority of animals don’t have bones. 95% of animal species don’t have bones, and when you look at the number of total animals — as opposed to species — the percentage is even higher.

6. Forty Acres and a Mule
How convenient that the marine was paid with a farm just outside of town. ? This is not the 18th century — who pays in farms anymore? Why not just say his parents left him a small farm outside of town; sounds more believable that way.

7. Those Who Do Not Know History
Didn’t we already have the bioweapon at the elite public gathering storyline?

An average episode. Nothing bad enough to advance the countdown, but nothing redeeming enough to reverse it. The Doomsday Countdown Clock stays at 11:56 11:55.

Tags: television fringe dna bioweapon telepathy

Jamie Pt wins this week with 14 points. Forny, Kirsten, and Mosaad all tied for second with 9 points.

Overall, Sapramiska takes the lead with 39 points. Jamie Pt and Tippi are tied for second with 37 points. Corien moves up to third with 36 points and Forny and Fran round out the top five (or six, actually) with 34 points. If your score is 30 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

Cuddy’s mother is back in an episode of House that was more soap opera than medicine — and yet, no Wilson.

Cuddy, her mother Arlene, and sister Julia are shopping for dresses when her mother complains of an irregular heart rate. When Cuddy detects atrial fibrillation she has Arlene admitted to the hospital. While there is some hypertension (high blood pressure) and borderline macrocytic anemia (anemia with abnormally large red blood cells), there is nothing that particularly alarms House. Her treadmill test comes back normal, so he plans on discharging her. She bombards him with fifteen years worth of minor symptoms such as dizziness, diarrhea, constipation, rashes, and joint pain, so he decides to keep her in the hospital to appease her. He sends a team to search her apartment and — in addition to finding some in flagrante delicto photos — they also find a bottle of Mexican herbal medicine. Since these are often high in lead, Arlene is started on chelation therapy for possible lead poisoning.

House feels that hypochondria explains most of Arlene’s symptoms and gives her placebo pills to prove his point. When she finds out, she fires him from the case. Cuddy convinces House to stay on “behind the scenes” while Dr. Kaufman, the head of Internal Medicine, takes over. Soon, Arlene’s atrial fibrillation starts up again and Dr. Kaufman suggests cardioversion (using medications or electrical shocks to return the heart to a normal rhythm; in this case Kaufman is clearly referring to electrical cardioversion because it is painful if one is awake during the procedure — which was apparently never carried out, or if it was, it failed). Looking over her symptoms, the team suspects leukemia, which is the same thing that Dr. Kaufman suspects and is testing for. House berates them for their suggestion, insisting that Arlene has thiamine deficiency, which he blames on her likely alcoholism. Cuddy confronts her mother about her drinking, but she denies being an alcoholic, so Cuddy tricks her into taking thiamine pills.

Arlene now begins to run a fever which rules out thiamine deficiency. Taub suggests an autoimmune disease such as SLE (lupus) — which again is the same thing Dr. Kaufman diagnosed and he has already started her on prednisone. Foreman suggests endocarditis (an infection of the heart valves) and House agrees. If it is endocarditis, then the prednisone will make the condition worse because it suppresses the immune system. With the assistance of Cuddy, they switch out the prednisone for an antibiotic without Dr. Kaufman knowing.

Unfortunately, Arlene now develops an allergic reaction to the antibiotic with wheezing, shortness of breath, and pruritus (itching). Cuddy switches the antibiotic back to prednisone and the allergic symptoms resolve, but the atrial fibrillation and fever return. House now suspects Arlene has a fungal endocarditis and wants to start Amphotericin B, a particularly nasty antifungal. The team balks as there are many potential pitfalls when using Amphotericin, especially if carried out covertly. Despite being threatened by House, M³ works up the nerve to tell Dr. Kaufman what’s been going on behind his back and he is livid. Arlene is also furious and demands to be transferred to another hospital. After a discussion with House about how she never stands up to her mother, Cuddy confronts her and tells her that while the care may be friendlier at another hospital, but she’ll die there. It works and Arlene decides to stay at Princeton-Plainsboro.

As Arlene is being wheeled back to her room, she makes a comment that shows she misunderstood one of House’s clearly sarcastic comments. House quickly confirms that she is unable to detect sarcasm which suggests a problem with her right parahippocampal gyrus (a part of the brain used to decipher social context, such as sarcasm). Since the neurological symptoms started before the fever, it makes the diagnosis of endocarditis less likely. Instead, House returns to heavy metal poisoning. No lead this time, but cobalt, from a worn hip replacement. He confirms this by exposing the muscle around the implant which is discolored from the toxicity. Arlene is started again on chelation therapy and given a new hip.

This episode had a number of abbreviations mentioned without much context to figure them out:
M&M: Morbidity and mortality conferences are held by departments and hospitals to review and evaluate cases with bad patient outcomes.
DDX: Differential diagnosis
AOA: Alpha omega alpha, a national honor society for medical students

Not that much actual medicine this week, so not as much to criticize. Surprisingly, for yet another week, I found nothing I considered a major error. There were the usual jumping to unsupported diagnosis errors, but nothing that made me cringe too bad.

As usual, major complaints are in red (none this week), more minor complaints are in blue, and nit-picking ones in green:

A treadmill test will tell you if there is ischemic heart disease — which atrial fibrillation can cause, and can sometimes be caused by — but won’t help much in Arlene’s case. The key tests are to figure out why she is in atrial fibrillation. Only one test, thyroid, was mentioned and only in a discussion of outpatient care. Also, it would extremely difficult, if not impossible, to interpret a treadmill test on someone in atrial fibrillation.

That much hip muscle damage, but no significant hip pain? It should at least be worse than her other joints, and should have prevented her from performing a treadmill test.

I see many case reports of cobalt toxicity from hip replacement and cardiomyopathy and heart failure, but no mentions of atrial fibrillation.

If she had fungal endocarditis, why did her symptoms improve on the antibiotics? (Same question, just replace “fungal endocarditis” with “cobalt poisoning”)

House seems decidedly unconcerned about her atrial fibrillation. “It may get better on its own, or it may not…” If she’s in chronic atrial fibrillation, she’s probably going to need anticoagulation (blood thinning medication).

Low cobalt levels can lead to B12 deficiency which can lead to macrocytic anemia. Elevated cobalt levels lead to polycythemia — too many red blood cells — the opposite of anemia.

Yes, going against a patient’s DNR has been viewed as assault in certain cases, but M³ wasn’t initiating treatment, just running some tests. I doubt this would violate the DNR (tests of one sort or another have to be run on all patients), and she did perform the testing under House’s implied suggestion, even if it wasn’t verbal. No prosecutor would touch the case.

The medical mystery this week was only interesting because of who the patient was, not due to the mystery itself: C-. The final solution was logical — and well documented — and fit many of her symptoms. I give it a B+ The medicine was sparse, but above average. It earns a B. The soap opera was good, but was severely lacking in Wilson. For that, I can only give it a weak B.

This week’s House Challenge scores have been posted.

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

With Abraham Lincoln’s birthday just around the corner, this seemed like the perfect time to bring out this wordy public service ad, which manages to tie together Abraham Lincoln, his Gettysburg Address, the United Nations Commission on Human Rights, and Superman in just a handful of panels. The intentions are good, but the PSA is less than compelling.

Click on the image for the full ad

This PSA was written by Jack Schiff with art by Win Mortimer. It was published in DC comics from April 1951 — this particular copy was scanned in from Adventure Comics #163.

More PSAs

Tags: comics psa superman abraham lincoln united nations jack schiff win mortimer

Click on the image for the full ad

Back when candy bars were considered healthy sources of energy (or at least marketed that way). You’ll also notice this was published before the Air Force split off from the Army, as the planes in the ad are referred to as Army planes.

Captain America Comics #24 (March 1943)

Three Nurses is a comic that lasted for six issues in the mid-60s — the strange numbering is because Three Nurses took over from Confidential Diary, and then itself became Career Girl Romances with issue #24.

Each issue of Three Nurses had stories, as the title suggests, of three different nurses: student nurse Lee Barry, registered nurses Anne Allen, and visiting nurse Nancy White. This week I’m going to look at the first story in Three Nurses #19, a tale starring Lee Barry.

Friday Nurse Day #5:
Three Nurses #19 “Death Trap”

Lee is a student nurse at the hospital and currently assigned to the top floor, where sick and wounded criminals from the local jail are kept in special hospital rooms. Appalled at how a Federal marshal is treating one of the patients, she gives him a piece of her mind:

The marshal explains that the prisoner is a member of the Masconi crime family. Gino Masconi, the head of the family, had recently been deported but rumors suggest he has come back to the States. The marshal is leaning on the prisoner to learn Gino’s whereabouts. Lee shoos the agent away from her patient.

That night, as Lee is leaving the hospital, she is kidnapped by some of Gino Masconi’s men. They put her in a motorboat and head out to Gino’s yacht, anchored just outside the three mile limit. Aboard the yacht, Lee meets Gino, his face wrapped in bandages from recent plastic surgery, and Doc Keller, the unlicensed doctor who performed the surgery. Gino tells Lee she will be his nurse now.

Keller pulls Lee aside and tells her that both their lives are in danger. Once the bandages are removed, she and the doctor will be the only ones besides Gino’s men who know what Gino looks like — and they are sure to be killed to keep the knowledge secret. A short time later, she hears a gunshot and then the sound of something being thrown over the side of the boat. Doc Keller is nowhere to be found.

Gino calls for Lee, telling her that he has indigestion and wants her to mix some medicine for him. Dutifully, she makes a stomach remedy and gives it to him. He drinks it down, and then begins to feel dizzy. She tells Gino that she has poisoned him and his only chance to survive is to go inland to the hospital. At first he refuses, but his symptoms worsen and he finally gives in.

Gino, his men, and Lee all take the motorboat to shore. Just as they land, a team of Federal agents arrive and save the day. They had been warned by Doc Keller, who, though shot and thrown overboard, had made it to safety in time to warn the G-Men. Lee reveals her own deception: Gino was never poisoned; she had simply given him a heavy dose of narcotic and made him think he was going to die. In the end, Gino goes to prison and Lee gets a date with the Federal marshal, the same one she had argued with the day before.

Vitals:

Published: July, 1963 by Charlton Comics

Cover price: 12¢

Time Capsule: The special floor for prisoners. This may still be used in hospitals that see a lot of prisoners, but given the need for hospital beds and space, I doubt it. Every time I’ve treated a prisoner, they’re in a normal bed, in a corner room, with a Sheriff watching over the room 24/7.

Most progressive moment: Lee thinks nothing of standing up for herself, whether talking to a Federal agent or murderous mobster.

Inexplicable: Doc Keller manages to swim three miles to shore and arrive in time to warn the Federal agents — all in the few minutes it took Lee to bluff the thugs and then take a motorboat back to land. That is some Olympic level swimming — and let’s not forgot he did all this while wounded.

Also, for a main character, Lee is a miserable nurse. The head nurse says as much in the first few panels of the story, and that’s why Lee is assigned to the prisoner floor — as punishment. Nothing she does after that makes me any more confident in her nursing skills.

Previous Friday Nurse Days:

#1: Three Loves	#2: Fire Storm
#3: Memories of the Past	#4: Doctor’s Love

It’s nice to have Fringe back in the alternate universe. This was a good episode, creepy for sure, and one that definitely changes the status quo

The Plot: Fauxlivia picks up her boyfriend Frank at the Empire State Building airship station. At the bar at the dock, two men – one of them a scientist named Silva — make small talk. Silva distracts his conversational partner, then switches their drinks. A short time later, the victim of the switched drink is violently retching in the bathroom as beetles eat their way out through his skin. Silva collects a couple of these beetles and nonchalantly strolls out.

The Fringe Team is called to the airship station for investigation of a “spontaneous bug eruption.” No insect data base they have can identify the beetles, and the team finds only a single live specimen.

Back at the Department of Defense, experiments continue on the chemical they extracted from Olivia (i.e. cortexiphan). After receiving a second injection, one patient develops telekinetic abilities — for a short time anyway, until he collapses in pain, apparently killed by the cortexiphan. Walter mentions that all the other patients in the experiment died. Alternate Brandon points out that the patient who developed telekinesis was the youngest of the patients, and he wants to try the cortexiphan on children. Walternate draws the line and tells him absolutely no experimenting on children.

Fauxlivia and Charlie arrive at an insect lab asking for assistance. Mona, the lab tech, recognizes Charlie from when he was initially infected with spiders and is clearly quite smitten. She eventually recognizes the bug as Mansonium boogliosis, the “Skelter beetle”. It was an obligate sheep parasite – not the use of “was” — the beetle died out 10 years ago, shortly after all the sheep did.

In his lab, Silva dissects the bugs he collected, but the results are clearly not what he was looking for. Next we see him at a local diner, ordering the same dinner as the man next to him. A short time later, when this guy dies, eaten by beetles, Silva is nearby collecting the insects.

The Fringe Team determines that the initial bug eruption seems to be an isolated case and not an outbreak. They put a “Fringe Alert” on television asking for help identifying the insect. They get a call from a scientist who used to work with Dr Silva, who was using the skelter bugs to develop an avian flu vaccine. Fauxlivia’s boyfriend Frank, through use of his CDC connections, is able to get more details on Dr Silva. He also identifies the equipment Silva would need to start his own laboratory. Agent Lincoln tracks a shipment of these supplies to a warehouse in Brooklyn. Lincoln and Fauxlivia investigate the warehouse — it appears deserted, but they suspect someone is in there with them. Soon, Lincoln is locked in a walk-in freezer and Fauxlivia crashes through the rotten floor of the warehouse and is captured by Silva. He gives her some water to drink that apparently contained some beetle eggs. Lincoln frees himself from the freezer and calls in a backup team. Silva is captured. Frank arrives and Fauxlivia is transported to the hospital. Frank is all ready to inject her with a potent anti-parasitic when it turns out that Fauxlivia is not infected at all, but pregnant. Dr Silva had infected himself and became the final victim of the beetles.

Poor Frank, he had asked Olivia to marry him, but now she is pregnant with a child that is clearly not his. He walks out of her room and moves out of their house. As the episode ends, Walternate arrives to comfort Fauxlivia, reminding her that she is the mother-to-be of his grandchild.

1. Hopefully, There Is No Alternate Jenny McCarthy
Jonas Salk was the researcher who developed the best known polio vaccine. His vaccine used a killed polio virus, and thus did not have the risk of wild-type reversion (infection with an active polio virus) that can sometimes occur with a live virus vaccine. I’m unsure of why Silva would suggest Salk had killed people in pursuit of his vaccine as this simply is not true. Experiments with the Sabin vaccine (a live virus vaccine) did end up with some patients contracting polio and dying, but this had nothing to do with Salk. There was also the so-called Cutter Incident where a batch of the Salk vaccine was contaminated with live polio virus, which did result in some deaths – but this had nothing to do with Salk himself.
Louis Pasteur was a French scientist from the 19th century. Every time you drink milk and don’t die, you owe it to him (assuming your drinking pasteurized milk – if it’s raw milk, then good luck to you and say hello to Brucellosis for me). He was an early vaccine researcher. He certainly took risks – all vaccine researchers did back then – but again I know of no deaths directly attributable to Pasteur and his vaccine work.
Of course it could be that Silva was right and the alternate Pasteur and Salk did kill patients in their research.

2. Alternotes
Over there:
All sheep died off 10 years gao.
Apparently all of Boston has been amber-ified.
Airship still dock at the empire state building.
An Avian Flu outbreak in the last ten years has killed millions.
Samuel Clemens is not routinely referred to by the more common (here at least) “mark Twain”

3. Oh The Humanity
In our world, the Empire State Building was originally designed to have a airship dock and terminal as well. The plan was scrapped after a few months when it was discovered the updrafts caused by the building itself made mooring an airship dangerous.

4. Somewhere, Vincent Bugliosi Is Upset
Though the closed captioning referred to the beetle as “Mahnsonium boogliosis,” to me it is clear that this should be “Mansonium boogliosis” as it a definite reference to Charles Manson, who is famously associated with the phrase Helter Skelter (as in the Beatle’s song and the source of the name “skelter beetle”).

5. The Beetles!
Coleoptera is the largest order of insects; it’s the beetle order. Archostemata is the smallest suborder of beetles. They are relatively rare and fairly primitive – similar in many ways to fossil beetles.

6. I Call Lab Shenanigans
Plasmids are a form of DNA molecule used by some bacteria, so I’m not sure how helpful they would be in a virus lab.
The way they mentioned the liquid nitrogen (all that fancy equipment then plain old “liquid nitrogen”) you just knew it was going to come into play later.

7. Bad Romance
Convenient that other universe ambulances carry portable ultrasound machines. It’s also convenient that Frank turned the machine not on Faulivia’s stomach area — the most likely place the eggs would be and found high in the abdomen — but on her pelvic area (and it did appear to be a fairly accurate ultrasound for a six-week pregnancy).

8. Fluke, Beetle, What’s the Difference?
Metrifonate is a real drug. It is an organophosphate acetylcholinesterase inhibitor and has been used to treat schistosomiasis (an infection by parasitic flukes — not close to an insect infestation at all). It is no longer available commercially in our universe, but apparently it still is over there. And apparently, there must be schistosomiasis problems in Texas over there, since Frank had it in his bag.

A solidly creepy episode that also managed to advance the überplot. I’m sad to see Frank go, but at least he acquitted himself well this episode — unlike Lincoln (locked in a freezer?). The Fringe Doomsday Clock moves back one minute to 11:54.

Tags: television fringe beetles fauxlivia pregnant

It’s been a couple of years, but in honor of Valentine’s Day, here are a handful more Legion of Super-Heroes Valentine’s Day Cards:

Previous Comic Book Valentines:
♥Legion of Super-Heroes (2008)
♥Legion of Super-Heroes (2007)
♥Legion of Super-Heroes (2006)
♥All my Legion cards on one page.
♥Watchmen
♥Spider-Man
♥The Legion of Doom
♥The X-Men

Though nobody came up with McLeod’s Syndrome, it was a high scoring week with multiple common autoimmune disease mentioned by name. I also went back and corrected any previous mistakes in scoring that were brought to my attention or that I noticed myself.

brism19 and Eli top this week with 16 points. Silvina comes in third with 15 points, followed by atg and Karatesocks in fourth with 13 points.

Overall, Jamie Pt takes the lead with 49 points. Tippi is in second with 48 points. Corien stays in third with 47 points. atg is in fourth with 46 points and Fran rounds out the top five with 44 points. If your score is 40 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

A below average episode of House with more-unrealistic-than-usual medicine and a more-unrealistic-than-usual final solution. At least Wilson was back this week.

Nadia is a waitress in her mid-thirties who has perfect memory — she never forgets anything, or anyone. One day at work, she suddenly collapses, both her legs paralyzed. Though it is just a temporary paralysis, she is admitted to House’s team for work-up. In addition to the episode of paralysis, she is also noted to have elevated CK (creatine kinase, a muscle protein) levels. There is debate among the team about her perfect memory, and whether that’s a symptom or not. An MRI of her brain was negative for stroke or tumor (notice how carefully that was phrased: not a negative study overall, but just negative for those two specific diagnoses). The initial diagnostic suggestions include toxin exposure, botulism, or alcoholism. Half the team is sent to look over her house, while the other half performs a thorough physical exam (which they should really do for every patient anyway). The search of her house turns an empty bottle of laxatives, so Taub suggests magnesium poisoning. House discounts that suggestion. Noting that the patient is constipated, he asks her how many times she’s stumbled or fallen over the past several years. As he suspected, she is falling more now than she used to, and he diagnoses her with early onset Parkinson’s disease and starts her on levodopa.

Nadia’s sister Elena stops by to visit and it is clear there is some unresolved issues between them. Nadia’s heart rate skyrockets — a wide complex tachycardia (an elevated heart rate that originates in the ventricles. This can degenerate into fatal arrhythmias like ventricular fibrillation so defibrillation can be appropriate). The cardiac symptoms mean that the diagnosis of Parkinson’s was wrong, so now the team throws out the ideas of elevated catecholamines (stress hormones such as adrenalin. High levels can occur with a pheochromocytoma), or long QT syndrome (an inherited heart condition that can lead to life-threatening arrhythmias) worsened by the stress of her sister’s visit. Under House’s suggestion, the team performs a cardiac stress test on Nadia using a fight with her sister as the stressor. The test is positive and she is started on beta blockers (a medication that lowers the blood pressure and slows the heart rate).

Chase now notices that Nadia has ammonia breath, which suggests kidney failure. This new information means the team needs to rethink their diagnoses again, and this time they come up with amyloidosis or an autoimmune disease (with Guillain-Barre, myositis, multiple sclerosis, polyarteritis nodosa, and SLE getting a shout out). She is started on steroids to treat the autoimmune disease and dialysis for the kidney failure. Things continue to deteriorate and Nadia develops shortness of breath and hives. It is determined that she is having a severe allergic reaction to the dialysis. Unfortunately, without dialysis, she’ll soon die. A kidney transplant is possible, but the waiting list is too long. Instead, the team decides to approach Elena who agrees to donate a kidney. The surgery is quickly performed and seems to go well at first, but then Nadia suffers a seizure while in the recovery room. And then the autoimmune tests all come back negative, so the suspected diagnosis was wrong. Now the differential diagnosis consists of acute porphyria or Factor V Leiden mutation (a condition that causes blood to clot more easily). House favors the latter, and Nadia is started on the blood thinner Heparin. Even with this treatment, Nadia is not doing any better, and is actually getting worse. She now has some uncontrollable movement of her left hand (chorea). Foreman suggests getting an MRI to look for a brain hemorrhage, but House wants a peripheral blood smear for acanthocytes (abnormally shaped red blood cells). Later, he comes in the room to talk to Nadia. He points out that she has obsessive compulsive disorder (OCD). Furthermore, he informs her that this and her other symptoms are due to a rare genetic condition known as McLeod’s Syndrome. Unfortunately, it is not curable, but it is controllable. After House leaves, Chase gives her a prescription for an SSRI ( — the class of drugs that includes Prozac, Zoloft, Paxil, Lexapro, and others) telling her that it will help with her OCD. As the episode end, she decides to try the medication in order to live a more normal life.

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

I don’t care if the donor was her sister, there’s no way that Nadia is going to get a kidney transplant without a firm diagnosis.

McLeod syndrome is an x-linked disorder. This means it is almost exclusively a male disease. Women with the affected gene are carriers, with mild symptoms at worst – however, their have a handful of cases of more severely affected women (felt to be due to unequal inactivation of the x chromosomes) but only one exhibited any symptoms near the level of disease Nadia was showing. Surely a good family history (she has that great memory after all) would turn up some siblings/cousins/uncles with neurological problems.

Nadia seems to have OCPD (obsessive compulsive personality disorder) more than OCD. Her symptoms seem more OCPD-like and ego syntonic than I would expect with OCD (and I consider it cheating for the writers to not even suggest such a major clue until the very end the way they did).
While people with hyperthymesia have been said to have some OCD-like characteristics, I’ve never seen it mentioned that they actually have OCD itself.

CK from the heart can easily be distinguished from CK from skeletal muscles or other sources.

McLeod’s will show up on an MRI, but then it’s not a “tumor” or “stroke” so I guess they didn’t look for it.

Before starting a blood thinner such as heparin you need some proof of blood clots, even if it’s just an elevated lab value (such as troponin or d-dimer). I guess you could argue that the elevated CK could have been CK-MB (the heart form of creatine kinase, and an elevated level can represent a heart attack) but then the heparin should have been started at the very beginning of the episode.

Levodopa is really never administered by itself anymore for Parkinson’s (too many side effects). It is prescribed in a combination form with carbidopa.

She was allergic to the hemodialysis, what about peritoneal dialysis?

Taub was always shown to be a plastic surgeon. Now he’s a pathologist too?

The medical mystery this week was barely intriguing and only got a little better as the episode went on. This is House, so you knew the hyperthymesia had to be a symptom: I give it aC. The final solution was a stretch, even by House standards. I give it a C-. The medicine was very sloppy and the sudden transplant was too much to believe: D+. The soap opera was pretty good, I liked that we saw more Wilson, and the Taub/Foreman pairing is always fun (I also liked the call back to video game episode); it earns a B+.

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

Buzzy’s back in this week’s public service ad, and for once, he’s not the only nosy one. His pal Jimmy is doing his share of prying as well.

Today’s PSA focuses on health, or more correctly, one of 156 different health careers for boys and girls.

Click on the image for the full ad

Men can be Pathologists, Physicians, and Statisticians. Women, apparently, are limited to Technician, Nurse’s Aide (what happened to Nurse?), and Dietician.

It’s nice to know I’ve chosen a career in an Important Field. In fact, that’s how I’m going to start introducing myself: “I’m Scott, and I have a career in an Important Field!”

This PSA was published in DC comics from June 1955, including Adventure Comics #213, the source of this scan. The script was by Jack Schiff with art by Win Mortimer.

More PSAs

Tags: comics medicine psa buzzy health jack schiff win mortimer

We already know that Kryptonian anatomy is screwy, but I didn’t think it was this bad.

Apparently Superman’s uvula is located in his left cheek rather than the back of his throat, where it belongs. A hint: if you follow the cleft in the center of the tongue all the way back, it should point to the uvula, not run parallel to it.

Here’s an annotated version showing where the uvula should be.

Image from Superman: the Man of Steel Annual #1. Stolen from Mike Sterling’s Progressive Ruin, where he used it as a perfect example of the horrible art in the Superman comic books from that era. Even more than the hideous art and perfectly linear hairlines, it was the totally aberrant anatomy that caught my eye and scarred my sleep for days to come. Thanks a lot, Mike.

Seeing the success Dell Comics had with such medical properties as Ben Casey and Dr. Kildare, Charlton Comics decided to produce their own medical comics. First, there was The Young Doctors, and then its spin-off title, Tom Brent, Young Intern. In addition to stories featuring the title characters, each comic also included back up features including short 2-4 page comics and occasional text pieces. This week’s nurse story comes from one of these back up features in Tom Brent #4.

Friday Nurse Day #6:
Doctor Tom Brent, Young Intern #4 “Weak Moment”

Dr. Ed Benson and Nurse Cynthia Doyle are young but extremely dedicated. Their shift started out well, but they have just experienced a heartbreaking emergency surgical case. Despite everything they did, all their medicines and all their skill, the patient died. The Chief Surgeon reassures them that they did all they could and furthermore, “from the patient’s chart and medical history, she didn’t have a chance anyway!” He recommends that the two of them to take some time away from the hospital to recover. He suggests that Dr. Benson take Nurse Doyle to dinner. When Benson declines, saying he has too much work to do, he is ordered by the Chief to go.

Despite Dr. Benson’s initial reluctance to go out, he and Cynthia have a great time — first at dinner, then dancing afterward. He walks her home and they kiss goodbye on her doorstep. Cynthia is ecstatic; she has had her eye on Dr. Benson for quite some time.

The next morning Cynthia can hardly restrain herself from running to work at the hospital so she can see Dr. Benson again.

I think we all can agree that Dr. Benson is huge idiot.

Vitals:

Published: August, 1963 by Charlton Comics

Cover price: 12¢

Time Capsule: In surgery, nobody is wearing eye protection, which OSHA requires now. Additionally, when the patient suffers cardiac arrest on the surgical table, Dr. Benson injects Coramine (an older drug no longer used for such purposes) directly into the heart.

Most progressive moment: Even with the Chief Surgeon’s orders, Cynthia still has to ask Ed out for the evening..

Inexplicable: Dr. Benson’s decision to forgo any romance, especially with the cute and fun and compassionate Cynthia Doyle. He’s they type of doctor who’ll be burned out by the time he’s thirty,and dead of a bleeding ulcer by thirty-five.

Previous Friday Nurse Days:

#1: Three Loves	#2: Fire Storm
#3: Memories of the Past	#4: Doctor’s Love
#5: Death Trap

A fairly predictable episode of Fringe tonight. The uberplot was advanced nicely, but this week’s action just felt shallow.

The Plot: Strange things are happening at the Rosencrantz apartment building. Half the residents have moved out over the strange goings on. Still, that doesn’t stop the couple in 7B from hosting a party. Unfortunately, the party is pretty much a disaster as their balcony becomes immaterial at one point, sending six people plunging to their deaths. The Fringe Team is called in and quickly realizes the building is somehow a weak spot between the two universes. Walter is worried that a vortex will appear at the site, destroying most of Brooklyn. He sends Peter and Olivia with a bevy of equipment to monitor the building. Meanwhile, he starts researching the amber jello first seen in Episode 3 (”The Ghost Network”) which is what the alternate universe uses to seal vortexes.

Monitoring the building – except when they’re having French fries in a nearby pub – Peter and Olivia quickly realize that whatever disturbance is going on, it is centered on Apartment 6B. They bust down the door and find an elderly widow talking to the “ghost” of her husband — except Peter can’t see the ghost, only Olivia and the widow can. Walter suspects that it’s not a ghost at all, but she is somehow seeing the alternate of her husband from the other universe – a sign a vortex is imminent. Walter proceeds with his amber plan, and even gets Broyles and his superiors to sign off on it.

Peter and Olivia don’t want to risk using the amber. They deduce that while the husband died in this universe, the wife must have died in the other universe. The combined grief of the remaining spouses is what is causing the universes to meld at that point.

Another episode of instability occurs, more intense than the last. Walter believes the time has come to deploy the amber. The building is evacuated – except for the widow in 6B who refuses to leave. The amber canister is emplaced and ready to release the gas. Peter and Olivia convince Broyles to give them a few minutes to talk to the widow. They figure if they can convince her to let go of the past, the vortex will seal on its own. When they arrive in the apartment this time, the breach is string enough that even Peter can see the ghost. Even the people outside the building can see the telltale glimmer in the window of the apartment. The widow refuses to let go, insisting that it is her husband. Now she can hear the “ghost” speak and he tells her how much he misses her – then he tells her how much their daughters miss her as well. In this universe, the widow and her husband never had children, so this makes her realize that it is not her husband, and she drops the connection. The vortex immediately subsides, just as Broyles was ready to release the amber gas. The world is saved – for now.

In a brief coda set in the other universe, Fauxlivia and Lincoln are puzzled when a high class disturbance set at the same apartment building in their universe abruptly stops for no reason.

1. Never Bet Against the House
The odds of flipping a coin and getting heads ten times in a row is 1 in 1024

2. Put Your Dread Pleasures More Into Command Than To Entreaty.
With a building named the Rosencrantz, Apartment 2B would have been a more apropos choice.

3. Apparently He Plays Dice with Emotions
“Spooky action at a distance” is an Einstein quote regarding quantum entanglement, but it was a quote disparaging it, not supporting it.

4. Did You Really Expect That to Work
Why did Broyles even ask Peter and Olivia to agree to evacuate when he ordered – he knew they weren’t going to listen. They haven’t yet.

5. Give It Some Distance
I’m unclear why separating the grieving widow and widower wouldn’t work in stopping — or at least slowing — the vortex. It was their proximity that started it, and surely there have been other alternate universe grieving couples before without incident.

While their weren’t really any significant errors or plot problems this week, it simply wasn’t a strong enough episode to improve the Doomsday Clock.

Tags: television fringe apartment ghost amber

A relatively low scoring week, though a lot of people scored points.

Harvey was top this week with 6 points. Too many people to name came in second with 5 points.

Overall, Tippi takes the lead with 53 points. Corien moves to second with 52 points. atg is in third with 51 points. Jamie Pt drops to fourth with 49 points. Gary, Gleb, and Harvey are all tied for fifth with 48 points. If your score is 42 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

A multilayered episode with multiple flashbacks and fictionalizations telling (despite what the title says) at least three stories: 1) a patient with shortness of breath, 2)why House is on the outs with Cuddy and what he does to fix it, and 3) why the fifth-grade girl has the black eye.

Not as good as Three Stories, one of the best episodes ever, this was a mostly entertaining though incredibly hard to believe episode. (At some point though, that fifth-grade teacher has got to learn when to draw the line, no matter what her kids say.) And did I mention the medicine was pretty poor?

Since this is a medical review blog, I’m going to focus on the patient:

A college student is admitted for severe cough and shortness of breath. The initial diagnosis was acute bronchitis, but cultures and sputum studies were negative. He was admitted to House’s team and his symptoms continue to worsen, with the patient developing hemoptysis (coughing up blood). The thought now was that the patient had a drug–resistant infection and he was started on oxygen, pulmonary suction, and bronchidilators (medicines like Albuterol). His symptoms continue to worsen and he coughs up a handful of lung tissue. The differential diagnosis now includes primary squamous carcinoma (the second most common lung cancer, unlikely because the FOB –fiberoptic bronchoscopy –was negative), infection (unlikely because he’s been on broad spectrum antibiotics), ruptured amebic liver abscess (unlikely because liver function tests are normal), or toxin exposure. Personally, House favors a diagnosis of sarcoidosis. He orders the team to carry out a thorascopic lung biopsy and run a C-ANCA test.

A CT shows no evidence of sarcoidosis or foreign bodies in the lung. Furthermore, the biopsy is negative for sarcoidosis, and the C-ANCA is also negative. Nevertheless, House wants to start the patient on corticosteroids and methotrexate. Later, Foreman calls too tell him that a PET scan was also checked and showed no sarcoidosis. House suggests this was because the therapy was working, but Foreman tells him that the therapy was never started. He also informs him that the patient is worsening as his lung his collapsing. House insists that Foreman start the treatment for sarcoidosis. Later, while being lectured by an elementary school principal, he sees a poster on her wall for The Princess and the Pea, giving him his weekly Eureka! moment. He deduces that the patient has inhaled a small piece of food — too small to be seen on CT scan — and this is what is causing his problems. He is scheduled for an exploratory surgery.

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

A pea-sized foreign body will show up on a CT scan. I’ve seen them pick up things smaller than that (1-2mm nodules, for instance).
You could also, successfully to my mind, argue that a foreign body that small is not likely to cause the severe symptoms that the patient has. For instance, why would it lead to coughing up lung tissue? (Unless it was the piece of lung containing the foreign body — and then you’d never be able to find the foreign body).

A “diagnosis of exclusion” refers to a condition for which there are no reliable tests. Because of this, other diagnoses must be ruled out first (i.e. excluded). If those tests are all negative, then the patient must have the remaining condition — the diagnosis of exclusion. To put it another way, to make the diagnosis, you have to rule everything else out. (A common example would be irritable bowel syndrome. There are no good tests for it, so other gastrointestinal conditions with similar symptoms are looked at first. If those results are negative, then the patient is likely to have irritable bowel syndrome). I mention this all to point out that Sarcoid is not a diagnosis of exclusion. House has ordered tests for it (admittedly, an incorrect test) so it is, by definition, not a diagnosis of exclusion.

C-ANCA is a test for Wegener’s Granulomatosis, not sarcoid.

Negative sputum and blood cultures do not rule out an acute bronchitis. Acute bronchitis is only bacterial 10-15% of the time, so 85-90% of the time the cultures are going to be negative, no matter what. Furthermore, even if it is bacterial, it’s tricky to obtain a good sputum culture and bronchitis is rarely — if ever — bacteremic so blood cultures are of no use.

If a patient is admitted with low O₂ sats, then he needs to be started on oxygen right away; there no reason to wait until he gets even worse.

The medical mystery this week was background story material, and it showed. Nothing exciting there: D. The final solution was unlikely, unless they have the world’s wost radiologists using CT scanners from the 1970s at Princeton Plainsboro. I give it a D-. The medicine was very sloppy, more expensive than usual, and incorrect: another D-. I’m of two minds about the soap opera. On one hand, it was fun to watch, but on the other hand, it didn’t add anything new. House acts like a dick to Cuddy? Tell us something we don’t know. I also found it hard to believe that House would be able get away with all he did in the classroom scenes. It was too over the top. Overall, I give the soap opera and non-medical storylines a weak C+.

This week’s House Challenge scores have been posted.

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

I was extremely saddened to hear about the untimely death of Dwayne McDuffie today. He was always one of my top writers, and I would pick up anything by him. His Milestone comics remain some of my favorites.

In addition to his more well known mainstream comic work, he was also the writer of many an above-average PSA comic — and as this is PSA Tuesday — I thought I would highlight a few of them.

The first three parts of the Amazing Spider-Man Canadian Drug public service comic tetralogy. These are not comics about drugs in Canada, or even about Canadian pharmacies, but a series of anti-drug PSA comics originally released in Canada, and then years later, sold in the United States.

Skating on Thin Ice	Double Trouble	Hit and Run

Click on the cover of the comic for my review of the issue in question. You’ll notice that McDuffie himself shows up in the comments to the first one, taking issue with one of my statements. (Reading it over again, I stand by my original comment, though his correction was certainly valid and I added an update to the post. In a brief e-mail correspondence later, he poked fun at the issue himself, admitting that the villainous plot of shipping drugs across the border in hockey pucks “deserved some skewering.”)

Riot at Robotworld

A comic written for National Engineering Week designed to get school children, and in particular minority school children, interested in engineering. Again, click on the cover for the full review.

Tags: comics psa spider-man dwayne mcduffie

Two weeks ago, Friday Nurse Day covered Death Trap, the first story from the Charlton comic Three Nurses. This week’s subject is the second story from the same comic. This one features “Registered Nurse Anne Allen” who always wears her nurse’s uniform — including white hat and blue cape — even when out on the town on a date

Friday Nurse Day #7:
Three Nurses #19 “Blindspot”

Registered Nurse Anne Allen is assigned to work with the aloof but handsome Dr. John Bailey on two new patients who have come in, victims of an accident at a nearby tenement. The first patient is Jim Carney, a self-admitted bum who’s been in trouble with law on and off for years. The second patient is Rose Delta, who is young and beautiful, but has been blind for years and is bitter about life. One night, walking up the stairs of the tenement, Carney stumbled and bumped into Susan, and they both ended up falling down several flights of stairs. They are admitted to the hospital for observation.

As Nurse Allen and Dr. Bailey work together, they become romantically involved. It starts with a dinner date, but soon they’re professing love for each other. One of the other nurses tries to warn Anne against Bailey, but Anne just figures it’s because she’s jealous.

Bailey and Allen discover that Carney has a brain tumor, and that’s what caused him to fall and injure Rose. Told that he has just weeks to live, Carney admits he’s led an awful life and would like to repent by offering his corneas to Susan after he dies.

Anne’s co-worker comes to her with a copy of the previous weekend’s paper. In the society section is an engagement announcement for Dr. Bailey — it seems that he’s engaged to a local debutante, the daughter of a wealthy family. Anne confronts John who admits he is engaged to another woman. He tells Anne that he loves them both. He plans on marrying his fiancée, since her family will set him up with a boutique medical practice; however, he still wants to keep his romance going with Anne because she reminds him of the hopeful soul of medicine. Summoning her courage and what’s left of her dignity, Anne walks away.

Anne goes to tell Rose the good news: that she’ll be getting a new pair of corneas and should be able to regain her vision. Through her tears, Anne goes on to tell Rose that everybody has blind spots, some can be fixed — like Rose’s — but some are permanent and cause people to overlook the good thing that’s right in front of them.

Vitals:

Published: July, 1963 by Charlton Comics

Cover price: 12¢

Time Capsule: This story could easily be reprinted today as nothing really identifies it as being from the 1960s, except maybe the use of the word “tenement” which isn’t used that much any more.

Most progressive moment: I’m not so sure it’s progressive as much as it is simply proud — when Anne walks away from Dr. Bailey without a word or a glance back.

Inexplicable: The bandages over Rose’s eyes keep appearing and disappearing. She’s been blind for years and didn’t injure her eyes in the fall — why does she need them bandaged anyway?

Previous Friday Nurse Days:

#1: Three Loves	#2: Fire Storm
#3: Memories of the Past	#4: Doctor’s Love
#5: Death Trap	#6: Weak Moment

Another Fringe episode that flashes back to 1980s, this time revealing the events occuring a few months after Peter was brought over. A solid episode that — like most good Fringe episodes — answers some important questions, but poses several more

The Plot: A young Peter Bishop, convinced that he doesn’t belong in our world, heads out over the ice-covered Reiden Lake. He ties himself to a cement block and starts smashing the block against the ice, wanting to get back to the “other world at the bottom of the lake.” Elizabeth Bishop arrives just in time to see him plunge through the ice. She dives in and brings him back to the surface.

Meanwhile, Walter is working with the Cortexiphan children in Florida, trying to get them to cross-over into the other universe, but having no success. After the ice escapade, Elizabeth is understandably worried and arrives at the daycare center with Peter in tow. We learn it’s been six months since Walter brought Peter across from the other universe, and for the past two months, Peter has been vocal that he does not belong here, and that Walter and Elizabeth are not his real parents. Walter tells his wife that he cannot personally cross over to return Peter, like he did before, because the universes are too unstable. Instead, he tells her, the Cortexiphan children should be able to cross-over and return Peter. He asks her to give him a little more time.

At her house, young Olivia has stayed up reading well past her bed time. Her step-father grabs the book and starts yelling and threatening her. In a blink, she finds herself teleported to an open field elsewhere, and then a second later, she teleports back home to the less-than-tender care of her step-father. The next morning at the daycare, she has a black eye, but assures everyone that she “fell.” Walter also notices her drawing a picture of a blimp and realizes that she has managed to cross-over into the other universe. He deduces that moving between universes must only occur when she is exposed to extreme emotions. In the lab, he tries joy, exhaustion, anger, and loneliness, but none of these work. He finally decides that fear must be the answer — not just fear alone, but a combination of love and fear, like what her step-father brings out in her. To prove his point, Walter stages a murder scene with one of Olivia’s friends pretending to be dead. He sure gets a reaction: Olivia sets the room on fire with pyrokinesis and then runs away.

Hearing the sirens rush by, Elizabeth is concerned that something must have happened at Walter’s work (so this has probably happened before). She and Peter arrive to find a small fire being put out, and learn that Olivia has gone missing. Elizabeth leaves Peter in the hallway while she goes to speak to Walter. Looking through Olivia’s notebook, Peter finds a picture of a field of tulips. He decides he knows where Olivia is, and heads off to find her.

We flash across to the alternate universe now, where Walternate and alt-Elizabeth are not handling the disappearance of Peter well. Walter has become quite the alcoholic and their marriage is strained to the breaking point. Rather than staying home to try and repair his relationship with his wife, Walter returns to work at Bishop Dynamic in Florida

Back in our universe, Peter finds Olivia just where he thought she’d be in the tulip field. They talk for a while and she admits that her black eye is from her step-father. He urges her to tell Walter the truth. When they arrive back at the daycare center, Olivia draws a new picture in her journal, then, when she is told her step-father is coming to pick her up, she decides to follow Peter’s advice and talk to Walter. She barges in his office and blurts out that her step-father has been hitting her and that was what led to cross-over into the alternate universe. Only it turns out – and I didn’t see this coming at all – that she just crossed-over again and told all this to Walternate instead of our Walter. This is how he learned of our universe and discovered what happened to Peter.

As the real Walter hands Olivia off to her step-father, he lets him know in no uncertain terms that he has his eye on Olivia and will report to social services if anything untoward happens to her. Later, talking to Elizabeth, Peter seems resigned to the fact that he is fated to remain in our universe.

1. I Would Love to Visit That Toystore — I Bet They Still Have the Original Micronauts.
There were quite a few anachronisms in that toy store. The one that caught my eye was the shelf full of the Battlestar Galactica board games (1978 – my best friend in elementary school had this – we combined it with his Snoopy Come Home game to make Battlestar: Snoopy Come Home) and the G.I. Joe playsets (1982, if not later). Still, it’s closer than having Ice Age toys in a 1980s daycare like they had the first time.

2. Alternotes
Over there:
Walternate is “safety czar” in his world (the term czar has been used for Presidential political appointees since FDR) and develop the Star Wars missile defense program.
Bishop Dynamic, instead of Massive Dynamic.

3. Appealing Question
I still wonder whatever happened to the alternate William Bell? Or Nina Sharp? They’re the only Alternates we have yet to see — or even hear about.

4. Purposeful or Simply Inept
When Walter threatened Olivia’s step-father (rather ineffectually, it seemed to me), was he really trying to protect Olivia, or was he trying to goad her step-father into abusing her again.

Minor historical accuracies aside, I thought this was a very good episode, and I did not see that twist at the end coming at all — but it fit and did not feel cheap. If there is any downside to this episode, it’s that it required a solid footing in Fringe mythology and not would be tough to understand as a first-time viewer. Regardless, this episode was good enough for the Fringe Doomsday Clock to gain another minute. (For the record, this is the furthest back the clock has ever been — I had to make a new graphic.)

Tags: television fringe olivia peter sortexiphan

The Sue Storm from the Ultimate Universe is sure having a tough life recently. Her ex-boyfriend turned into a universe destroying psycho killer. She had a cardiac arrest — and then poor treatment from the doctors. And now, while trying to save the remaining members of her team, she develops a psychic nosebleed. Will the indignities never end?

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed sue storm ultimate fantastic four

I though last week was low scoring, but this week is even worse.

karatesocks was the best this week with 4 points. There were about a dozen people tied for second with 3 points.

Overall, the top three remain unchanged with Tippi, Corien, and atg take first through third place, with 53 points, 52 points, and 51 points, respectively. Jamie Pt stays in fourth, but moves a point closer with 50 points. Gary and Gleb are tied for fifth with 49 points. If your score is 42 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

A good medical mystery on this week’s House, but the final diagnosis didn’t really fit. There were lots of little plot holes, too (M³ notices the condition of his hands, but his wife doesn’t?)

Bert takes the clean-up jobs no one else wants: crime scenes, septic tanks, mold removal. As the episode start, he is cleaning up copious amounts of blood at a murder scene. Of course, his wife doesn’t know this; she thinks he is still a real-estate developer. At their anniversary dinner, he breaks out in a sudden rash and starts struggling to breathe. He is admitted to the hospital under Dr. House’s service. House points out that the patient seems to having an allergic reaction, but has tested negative to “all known allergens.” Once the team learns what Bert really does, they realize he has been exposed to countless pathogens and toxins. The initial thoughts are either a fungal infection or a bacterial infection. House suspects the latter and has the patient started on antibiotics.

A search of Bert’s office turns up some illicit Vicodin as well as numerous cleaning compounds. The team now believes he has boric acid exposure and wants to decontaminate him. As they are explaining their suspicions to him, he suddenly spikes a high fever that require cooling blankets to bring down, and then only to 102º. The autopsy from the crime scene he was cleaning up showed no infectious agents, so a blood borne disease is ruled out. Foreman suggests a more common disease may be the cause so meningococcemia (a common type of bacterial meningitis) becomes the chief suspect, so a lumbar puncture (spinal tap) is checked. The results show no bacteria, but an elevated number of white cells. When they go to check on the patient, he is complaining of numbness and paralysis of the legs. The covers are dramatically thrown back to reveal cold blue discolored feet.

Circulation is restored to Bert’s legs (though how is never mentioned). The lumbar puncture tests do not suggest meningococcemia, but fit a viral meningitis better. M³ points out that they also fit serum sickness. House agrees with her, so the antibiotics are stopped and corticosteroids started. The rash resolves, but now Bert develops bilateral conjunctivitis — and more concerning — starts to hallucinate. The team debates whether Bert’s original disease has moved to the brain, or have the steroids caused the hallucinations? The differential diagnosis now includes Familial Mediterranean Fever or a systemic fungal infection. The initial fungal cultures were negative, but M³ points out that the saline used in cultures can sometimes inhibit fungal growth, so new cultures are drawn avoiding saline. Bert is started on a strong antifungal therapy.

Bert’s condition continues to worsen. His fever is back, and now he has lost his hearing. There is concern for Tumor Necrosis Factor syndrome, a brain tumor, or a viral infection. The tumor is the most concerning, so an MRI is ordered. Unfortunately, while getting the MRI, Bert has a seizure. He consequently develops severe kidney failure requiring dialysis and falls into a coma. House wants to start chemotherapy and radiation therapy for a suspected brain tumor. In the meantime, Bert’s rash has returned. The inciting factor seems to be exposure to cold (open windows at the crime scene, air conditioning in the MRI room) leading to a thought of cold urticaria (hives caused by exposure to cold). House finally deduces that Bert has a rare inherited condition known as Muckle-Wells Syndrome. Starting him on rilonacept should help with his condition, unfortunately, the diagnosis has arrived too late and Bert has flatlined and cannot be resuscitated.

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

Only superficially does Muckle-Wells Syndrome (MWS) fit. It is a recurrent episodic disease, so Bert should have experienced episodes of joint pains and fevers several times before — starting in his teens, if not earlier. Like many genetic syndromes, there is gradual onset of symptoms. For example, both the hearing loss and kidney failure are gradual not sudden (and again, start in the teens).
It’s an autosomal dominant disease, so one of his parents should have had similar symptoms.
He lives in New Jersey – you can’t tell me he’s never been exposed to the cold before.
Foreman shows shock at diagnosis a disease with only a few thousand reported cases in the United States, but in previous weeks has shown no shock when the team (not infrequently) diagnoses conditions with only a handful of recorded cases — ever.

The patient clots off arteries to both legs, which requires some sort of correction (surgical? medical?) and this is blown off and never mentioned again. This is a very significant and concerning symptom, and should have resulted in a full work-up all by itself — not just abandoned nonchalantly.
If I were a patient and having symptoms in my legs, I would remove the blankets and take a look myself.

Most clinicians check a CT scan before performing an LP (to make sure there is nothing that could cause a herniation when the LP is performed) – but then if they got a CT then when they were supposed to, they wouldn’t have needed a (cold) MRI later…

Part of the danger of fever is not just how high the temperature goes, but how fast the temperature changes. This also includes how fast the fever drops – you don’t want to drop the temperature too fast.

There is no way to test for “all known allergens” — there are thousands, if not millions, of things people are allergic to. Then a few scenes later they mention that they didn’t test for Vicodin allergy, though narcotics are common causes of allergies (so much for “all known allergens”).

The CSF showed a high white count, which was never really followed up on. Presumably, this is linked to the MWS, but I see no mention of it in a quick perusal of the literature.

MWS is a type of CAPS, the two are not synonymous.

Fungal cultures are slow growing and take a long time to come back negative (generally 2 weeks).

Before starting chemotherapy and radiation therapy, it helps to know which kind of cancer it is, because different cancers (even different brain tumors) require different therapies.

Kudos to Chase and M³ for treating the flatline properly. No defibrillation, just CPR and medication.

This week’s medical mystery was the first truly intriguing one in several episodes. It deserves an A-. The final solution was quite a stretch, even if you assume the team never took a good personal or family medical history. It earns a D. The medicine was decent — if you ignore the team skipping the CT and blowing off the clots, which were both quite important. I can;t give it anything higher than a C-. The soap opera was OK. Foreman and Taub, and Chase and M3 were good. Wilson was pretty good. But House and Cuddy had no spark or interest whatsoever. I give it a C.

This week’s House Challenge scores have been posted.

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