Polite Dissent

Another slow-boiling episode of Fringe without any flashy villains or monsters. One stop closer to culminating this season’s über-plot.

The Plot: As the episode begins, Peter is still in the hospital and being kept in a medically-induced coma. Walter and Astrid are at his bedside, while Olivia and Sam Weiss are trying to find a way to stop the machine.

A series of strange “dry” lightning storms strike the Eastern seaboard and the Fringe team – or what’s left of it — is called in to investigate. Astrid convinces Walter to return to his lab to look for answers. After playing Benjamin-Franklin-with-a-kite for a while, Walter realizes that the locations where lighting has stuck more than once is important. He overlays the lightning strike data with seismic and radiation data and it shows a series of concentric waves centered on two loci: the hangar where the machine is kept, and Liberty Island, where Walter realizes Walternate must keep their machine. He convinces Broyles to move our universe’s machine to Liberty Island because having the two machines is close proximity will slow the destructive process down.

Meanwhile, Sam Weiss explains to Olivia that he’s the latest in multiple generations of Sam Weisses, all dedicated to protecting the machine and the two universes. He knows of a hidden “crowbar” that will allow them access to the machine, even though its force field is on. After a few adventures, he and Olivia are able get their hands on this crowbar, only to discover that it’s an old drawing of the Olivia and the machine, and it indicates that Olivia must use her powers to shut the force field down. Hearing this, Walter tells her that she needs to shut down the force field on the other universe’s machine, since that’s where the problem started. He goes on to explain that the part of her brain that controls her dimension-hopping also controls her telekinesis, so it should be no great problem for her to shut down the machine from this side.

Across town, Peter has woken up (so much for the medically induced coma) and made his way to Liberty Island. He is somewhat amnesic and seems to believe that he is still in the other universe. Walter and Olivia arrive and his memory seems to quickly return (convenient, hmmm?). Since the machine has arrived on Liberty Island, Peter and Olivia decide it is time to do their part. Olivia is able to shut the force field down with her telekinesis, causing a conniption fit in badBrandon. Peter climbs into the machine and finds himself propelled into some sort of dystopian future, where a new World Trade Center has been built, and he is now a full-fledged agent of Fringe Division.

1. Out of Focus
The product placement is getting ridiculous, but at least I’ve learned that a Ford Focus is the best place to be during a lightning storm — and apparently the best vehicle for accelerating backwards the wrong way down a crowded interstate. (Makes me wonder if Fringe is getting renewed not so much for the audience, but for the advertisers instead.)

2. Lightning Needs to Develop a Better Sense of Irony
So Mr. I’m-an-idiot not only gets out of the relative protection of his car during a lightning storm, but proceeds to climb to the highest point around to get a better look. All that was missing was him deciding to erect a metal flagpole.

3. Glad I’m Not on Staff There
Peter in the hospital:
He pulled out the IV backwards, which would have ripped a nice gash in his arm.
That loose an EEG band is never going to work.
All sorts of information on that bedside monitor, including heart rate (twice, and different, or maybe on is oxygenation level, but if that’s the case, he’s at death’s door), temperature (in Fahrenheit and Centigrade), and respiratory rate. Notice that despite having very different readings, the strips are identical for each vital sign.
Why are there no alarms when he pulled off everything? There would have been alarms galore: low oxygen, no heart rate, no blood pressure (now that’s not saying any hospital personnel would respond to the alarms, but there would have been alarms).
Someone in a medically induced coma would be in an ICU room, not a regular room.

4. Schadenfreude
This episode makes me wonder if the other universe’s machine wasn’t working as well as they hoped because Olivia wasn’t present. Did they sabotage their own efforts by separating Fauxlivia’s chromosomes out of the baby’s blood?

5. It’s a Tarp!
Add me to the list of people who wonder how the machine — which no one could touch because of the electrified force field — was moved from the hangar to Liberty Island. Must have been the blue tarp.

Another slow moving, build up the uber-plot, episode. Not a bad thing, but a little on the slow side. The Fringe Doomsday Clock remains, again, unmoved.

Tags: television fringe machine telekinesis sam weiss

A nice week, with quite a few scores of 10 or higher, and even more earning 5 points.

EverybodyLies wins this week with a score of 13 points, followed closely by Barak with 12 points. Markcb and TRad came in third with 11 points.

Overall, Jamie Ptremains in the lead with 70 points. Gary and Tippi are still tied for second with 64 points. Gleb moves up to fourth with 63 points, and Forny is in fifth with 62 points. If your score is 51 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

An uninspired and uninteresting episode of House with everyone just going through the motions. It’s like the writers knew what they had wasn’t that interesting so they kept trying to up the ante, but without bothering to have it make any sense. (What could be worse than a cancer? I know! Three cancers!)

Cyrus is a middle-aged former refrigerator repairman who recently won $42 million in the lottery. While out looking for his long lost love one day, he collapses as he suddenly becomes paralyzed in his left leg. He is admitted to Princeton-Plainsboro Hospital under House’s service for evaluation of his partial paralysis. House mentions that Cyrus’s initial work-up included a negative head CT, a negative lumbar puncture, a negative spinal MRI, and a normal EMG (Electromyogram — a test that checks the conductivity of muscles and nerves. The initial differential diagnosis consists of neuro-otological pathology, toxin exposure, or atherosclerosis caused by exposure to ceramics or precious metals. Taub is sent to get a better patient history, while Chase and Foreman investigate Cyrus’s repair shop. Taub discovers that Cyrus eats little but canned food, and wonders if this has caused a heavy metal poisoning. Chase and Foreman discover cheap off-brand solvent in the repair shop and suspect inhaled toxins. Thirteen points out that both of these can be cured by chelation, but House overrules her and wants Cyrus started on alkalynization and dirueses for the heavy metal toxicity, and then dialysis for the toxins if that doesn’t work. This way, he opines, they can know what the cause of Cyrus problem is.

Thanks to hospital politics, Cyrus is unable to go through with either House’s plan or Thirteen’s plan. As this is being explained to him, he develops sudden vomiting and shaking which Thirteen diagnoses as a focal seizure. The new differential diagnosis includes Lyme disease, postural hypotension, and herpes encephalitis. House favors the latter, so orders an EEG to confirm and starts the patient on Acyclovir (an anti-Herpes drug).

Off camera, Cyrus’s EEG shows no encephalitis, but does show “metabolic stress” which is traced to a mass in the pancreas suspicious for a tumor.

Undergoing a CT-guided biopsy of the pancreatic mass, the team notices two other masses — one in the colon and one in the kidney — also suspicious for cancer. Yet the findings on the CT suggest that these are three entirely different cancers. As to be expected, a new differential diagnosis is made, this time containing Von Hippel Lindau disease (a rare genetic disease that causes tumors and cysts to grow throughout the body) syndrome and the vague “missing a tumor suppression gene.” To discover the underlying reason, House decides his best bet is for the tumors to grow bigger, and maybe for new ones to form, so he can track down the inciting cause. He start Cyrus on a tumor growth factor.

Surprisingly, an abdominal ultrasound performed later shows no increase in tumors at all, and actually a decrease in tumor size. Autoimmune is mentioned as a possible cause, and then discarded, and then amyloidosis is brought up. It makes sense to House so he wants a GI biopsy to prove it’s amyloidosis, and then he wants Cyrus started on chemotherapy. Cyrus suffers an emotional blow at this point, betrayed by his best friend, and he suffers the hat trick of cardiac arrest, liver failure, and lung failure. Luckily, thanks to a scolding by Cuddy’s mother, House has his Eureka! moment and hediagnoses Cyrus with a teratoma.Teratomas are strange encapsulated tumors that contain all three cell-layers found in developing fetuses, and because of this, can develop almost any kind of tissue within them. In Cyrus’s case, the teratoma produced brain tissue, which somehow leaked into his bloodstream and caused an autoimmune response that attacked his own brain, leading to his paralysis and seizure. His teratoma also contained pancreatic, liver, and lung cancers which also leaked out and caused tumors in those particular organs — all at the same convenient time. House tells Cyrus that his problems — the medical ones at least — will resolve after the teratoma is surgically removed.

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

EEGs are not used in the diagnosis of herpes encephalitis. But guess what — lumbar punctures are! The same LP that we were told from the very beginning was negative.

I just don’t buy the teratoma as the cause of all Cyrus’s problems. So this teratoma not only has brain tissue that induces an autoimmune response, but has three distinct cancer lines within it as well. Why didn’t these cancerous cells make a massive tumor within the teratoma?

I’m quite familiar with the causes of atherosclerosis, and I don’t remember seeing ceramics or precious metals on the list.

Different chelating agents are used for different toxic exposures. There is no one general chelator. This also renders House’s argument void, since you tell what the inciting toxin was by which chelating agent worked.

Why didn’t the first CT scan used to find the pancreatic tumor also find the other two tumors?

Why would brain tissue from the teratoma lead to an autoimmune response? Why did it set off the immune system in the first place? It is “self” after all.

“Metabolic stress” is a very general term, why jump to an abdominal CT first thing?

This week’s medical mystery was, again, rather dull, at least from a House point of view. It earns a C. The final solution required to many coincidences to be believable: C-. The medicine, what little we saw, was wrong as often as right. It was awkward the way the almost-certainly-fatal diagnosis of pancreatic cancer was made entirely off camera and just alluded to in conversation. Another C. The soap opera was decent, and this is the most interest I’ve had in Arlene yet. The soap opera earns a B.

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

This week’s House Challenge scores have been posted.

Back in the early 1970s, King Features published fifteen different career guides all starring Popeye. Previously, I looked over Popeye and Public Service Careers. Today I’m going to take a look at another one of these public service comics: Popeye and Personal Service Careers.

What is a Personal Service Career? According to Popeye: “Personal Service Careers are those jobs that are done directly for people.” It’s not exactly the most enlightening explanation, is it?

What jobs does Popeye consider a Personal Service Career? Barbers, cosmetologists, manicurists, health salon instructors and operators, masseurs, masseuses, karate experts, dietician, chauffeurs, marriage counselors, psychologists, child care attendants, school bus drivers, developmental psychologists, social workers, and veterinarians. Of these, the barber, cosmetologist, and marriage counselor get the most pages.

As this is an informational comic for high school students in search of a future, each career lists education requirements, as well as any necessary licenses. Salary isn’t mentioned, even in the most general way, but work-hours and job satisfaction are provided (“Full-time barbers usually work about 50 hours a week. They have good working conditions and are generally satisfied with their work.”)

The wording of the comic is frequently stilted and awkward. The writer has gone to great lengths to avoid using contractions, and the result is very unnatural. The jokes are generally pretty lame too and, like the comic itself, show a subtle yet common misogyny.

A few careers are mentioned that no longer exist. How about a child care attendant who works in a department store nursery, so the mother can go shopping without her children in the way? Or the movie theater matron, who is “expected to maintain order among kids in the childrens [sic] section” so the adults can enjoy the film?

I’m a little unclear how veterinarian fits the definition of Personal Service Career. I’m guessing it didn’t fit in any of the other comics, so they shoe horned it in here.

Popeye and Personal Service Careers also contains an image that, once seen, cannot be unseen. For those of weak constitution, stop reading here. Do not go on!

Don’t say I didn’t warn you!

Little Lord Fauntleroy Popeye, complete with sailor suit, ringlets of hair, pipe, and tattoo.

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Tags: comics psa popeye career personal service

Unless comic books have been lying to me, the number one cause of doctors’ deaths in the Golden Age was mobsters.

Just to be safe, from now on, the first thing I’m doing is asking all my patients if they’re mobsters.

The season finale for this season of Fringe, answering a lot of questions, but leaving a few more…

Peter awakens in the middle of a fringe event in the dystopic future of 2026. He sustains some mild injuries and is taken to Fringe Medical for evaluation. He quickly forgets any connection to 2011 and as far as he knows, he is 47 year-old Fringe Agent Peter Bishop. As far as the future of 2016 is concerned, things started to go bad back in 2011 when Peter used the machine to destroy the alternate universe and save ours. It turns out that the two universes needed each other to survive, so without the alternate universe, our universe is breaking down. There have been other changes as well: Peter and Olivia are married, and Olivia is now the head of Fringe Division. Astrid is a Fringe field agent, as is Olivia’s niece Ella, all grown up. Broyles is a U.S. Senator. And Walter is locked away in a maximum security prison, a pariah to all, blamed for the impending and inevitable destruction of our world.

Working within the chaos of the future is a terrorist group know as the End-of-Days who are, as their name suggests, trying to end the world a little faster. They do this by using special gadgets that exacerbate the universe’s breakdown. These neat little gadgets are being supplied by Walternate — it seems he crossed universes fifteen years ago, and ended up trapped in ours when his universe was destroyed. He has been plotting his revenge since. He lures Peter to their old summer house, and then shows up in New York and shoots and kills Olivia. About this time, Walter works out that the giant wormhole in Central Park is not only a wormhole through time, but is what he must have used to send the pieces of the machine back in time. You see, Walter is the “First People” and he is the one who is responsible for the pieces of the machine ending up scattered back in time. He also realizes that he can use the time-wormhole to reach back to Peter in 2011 and bring him forward in time to 2026 so he can see what happened to the world. Forewarned, Peter can then make the proper decision once in the machine back in 2011. Which is how the Peter of 2011 ended up in 2026 at the end of the previous episode.

Back in our time, Peter uses the machine to link both universes at the Liberty Island facility, actually bringing Walternate, Fauxlivia, badBrandon and their team over to our universe, so that they can work together to fix the problem. In middle of his explanation, Peter suddenly fades away and no once seems to notice. Outside the facility, a group of Observers have gathered to, well, observe, and they mention that since Peter has now served his purpose, there is no need for him to exist.

1. In the Beginning…
I noticed it was a new Fringe opening tonight, or at least the fringe science terms were new ones. Ominously, the last two words were “water” and “hope.”

2. I Need Sustenance
Apparently, in the future, all wine comes from boxes, and steaks from cans. Cans which must be kept frozen – which kind of defeats the purposed of canned food.

3. Bad Medicine
Apparently Fringe Medical has forgotten that a c-collar is supposed to immobilize the neck.
I meant to mention this last week, but it was even worse this week: that was a horrible job of applying steri-strips to Peter’s facial wounds. Gonna leave scars.

4. It Is By Will Alone I Set My Mind In Motion
I used to make fun of alternate Astrid by calling her a Mentat, but was had an honest to god Mentat in this episode with Brad Dourif as “Moreau” (a name with a good mad science lineage).

5. Alphabet Soup
I’m familiar with Alpha, Beta, and Gamma radiation. Delta and epsilon radiation have been described as well. And Kappa radiation is apparently associated with time travel. So what’s the story with Zeta, Eta, Theta and Iota radiation?

6. Alphabet Soup
The images of the vortex in the Thames looked suspiciously identical to the scenes from the execrable second Fantastic Four movie: The Rise of the Silver Surfer.

7. Chicken, Egg, Both, neither?
So we end up with one of those great science fiction paradoxes: no one actually designed or created the machine. The modern Fringe teams found the pieces and instructions and built it, and the future Fringe team sent it back in time — but no one actually built the original parts. Much like no one actually wrote the poems of William Ashbless or Lallafa (to name two other similar classic science-fiction time paradoxes).

8. Final Question
If Peter never existed, why did Walter cross universes in the first place?

I liked this episode. Sure, it was filled with cliches, but they were classic cliches, and done well. The Fringe Doomsday Clock moves back another minute.

Tags: television fringe machine telekinesis sam weiss

Thanks to Foreman mentioning a handful of common condition, almost everyone scored at least 1 point this week. No particularly high scorers though.

Joe Giliberti and zkeramid won this week with 7 points. Corien was in third with 6 points, and Gaut and Indyfrick took fourth with 5 points.

Overall, Jamie Pt remains in the lead with 72 points. Corien and Forny have vaulted into a tie for second with 66 points each. Tippi falls to fourth with 65 points. Gary and Kirsten are tied for fifth with 64 points. If your score is 54 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

Another relatively uninteresting episode of House, despite having two patients.

Wendy Lee, a weapons designer, suffers a tonic-clonic seizure in the middle of a weapons demonstration and is admitted to House’s team. According to House, her initial differential diagnosis consists of a brain tumor or a brain bleed, so Foreman orders an MRI.

The MRI is normal, and the team learns that Lee has a vindictive ex-boyfriend and may be a victim of poisoning, but her toxin screens were negative. Chase wants to start her on activated charcoal, just to be on the safe side. The team searches both Lee’s and her ex-boyfriend’s house. The search of Lee’s house turns up a crate of empty liquor bottles, so the team now suspects she may be an alcoholic, which she denies. They start her on Valium to assist with alcohol withdrawal. Next she develops severe stabbing abdominal pain that requires morphine for relief. Foreman takes this as a sign of acute pancreatitis, which can be related to alcohol use. Thirteen thinks Lee has a stress-related condition, and Chase thinks she has pyelonephritis, a kidney infection.

Lee has another seizure and the tests have all been normal, so the team is back to square one. Chase posits that the CT scan and ultrasound show some inflammation around the kidney, so suggests that Lee may have an obstructing kidney stone or a perinephric abscess. Taub thinks she is having neurological symptoms secondary to a urinary tract infection, so starts her on ampicillin and an aminoglycoside antibiotic.

Lee takes a turn for the worse, developing ventricular tachycardia and then a heart attack. Surgery is performed to place an AICD (automatic implantable cardioverter defibrillator), but during surgery, Lee is noted to have both rectal and vaginal bleeding. The differential diagnosis now consists of a surgical error, a blood clotting disorder, or toxin exposure. Foreman goes further and lists cancer, sepsis, trauma, liver disease, and hemorrhagic fever as possibilities as well. Lee then develops bleeding gums, leading to a new differential of candidiasis (a severe yeast infection) or acute myelogenous leukemia (AML). The team ultimately decides she has AML caused by radiation exposure, most likely from her work. They place her in isolation and ready a bone marrow transplant. It is then that her swollen genitals are noticed. Once again, this changes the differential. Chase and Thirteen confront her boyfriend who eventually admits that due to her infidelity, he has been poisoning her with Spanish Fly (a very irritating chemical that can be — allegedly — used as an aphrodisiac, but there is a thin line between useful dose and toxic dose).

Meanwhile, House has lost a bet over a boxing match to Wilson. Unwilling to concede defeat, he thinks that his fighter either threw the match, or has something medically wrong with him. Initially House suspects an abnormal heart rhythm like Wolff-Parkinson-White (WPW), but the tests are negative. Next he thinks the boxer has sympathetic overdrive, but is proven wrong. Then he suspects water intoxication relating to a kidney disorder, but his tests again show he is wrong. Finally he proves that the boxer has a glomus tumor, which caused him to pass out shortly after it was pressed.

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

Taub stalks out when Foreman starts listing all the things that could cause Lee’s condition, implying that is the wrong way of going about treating the patient. Apparently Taub (and the writers) are unfamiliar with the true concept of differential diagnosis, because that is just what Foreman is doing – listing all the possible causes – the differential diagnoses, if you will – of Lee’s condition.
Taub stating he’ll treat the symptoms sounds good in practice, but is problematic in reality without knowing the underlying cause. For example: the patient’s seizures. If they are classic grand mal seizures, then that’s one treatment. Alcohol withdrawal seizures uses a different treatment. Or maybe it’s eclampsia – she could be pregnant – and those seizure require still another different treatment.

Activated charcoal won’t do any good once the poison has passed from the gastrointestinal tract, which would have been the case when Chase suggested using it. (Of course, Chase may have ended up being right to suggest using it, since Cesar must have still been poisoning her in the hospital — but as far as the team knew at the time, any poison exposure would have been hours, if not days, before.)

The tests show no urinary or kidney infections, so the very next thing Taub claims Lee has a urinary infection.

The ultrasound and CT scan which showed the inflammation around the kidney probably would have shown the kidney stone too, or at least signs of urinary obstruction. They should also have shown a perinephric abscess.

A quick and simple blood test will show pancreatitis.

I’m willing to bet that the research scientists have a better way of getting experimental drug “CS-804″ into suspension, and that heating the drug like that may very well ruin it.

This week’s medical mystery was rather pedestrian. There haven’t been any cases that started interestingly for several episode now. The boxer was a little more interesting, but that was mainly for the potential House/Wilson conflict. The medical mystery gets a C . The final solution fits, assuming Cesar kept poisoning her while she was in the hospital. The boxing solution was more of a stretch. I give them a B-. The medicine, in both cases, was very sloppy and demonstrated beyond a reasonable doubt that the writers have no idea what a differential diagnosis actually is: D. Another C. The soap opera was barely there and fairly week and deserves only a C.

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

This week’s House Challenge scores have been posted.

With the subtitle of “A true story from the records of the Minnesota Warden Service” you’d be forgiven if you thought this was going to be an exciting or interesting public service ad — and you’d also be wrong.

Apparently nothing exciting happens in Minnesota because the readers are treated to a selection of tried and true outdoor safety nuggets: Wear your life jacket. Don’t wander off in unfamiliar territory alone. Check for water depth before diving. Extinguish all campfires. Important information to be sure, but nothing we haven’t seen before.

Click on the image for the full ad

Did Schiff actually review the records of the Minnesota Warden Service? And this is the best he could come up with? Where’s the bear attacks? The outboard motor dismemberments? The emergency medical evacuations? The acres of wildfires?

I propose a new motto for Minnesota: Land of Ten-Thousand Lakes, and Really Bored Wardens.

Looking at the second panel, I bet the kids were doing fine in the canoe and only swamped when Warden Hodge landed his plane right on top of them.

This PSA can be found in DC comics from October 1963, which probably explains its blandness. The PSAs from the later years of DC’s program seemed to lack the spark that made the early ones interesting. I’m guessing fifteen years of writing PSAs is enough to sap the life and interest out of any man.

Jack Schiff — with some help from the Records of the Minnesota Warden Service — wrote the script and Sheldon Moldoff provided the art.

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Tags: comics psa minnesota warden campfire jack schiff sheldon moldoff

In the far off year of 2056, the warlike aliens the Zlovian have invaded our solar system in their city-sized space ship made out of the indestructible element impervium. Desperate, the Planeteers decide to send a spy onto the Zlovian ship to learn the secret of impervium.

Tommy Tomorrow is selected for the mission. So he won’t be detected on board the enemy ship, he is given a special Bio Serum that will transform him into a Zlovian. He is also given the antidote, which will change him back.

Once aboard the alien ship, Tommy is quickly able to determine the weakness of impervium. His disguise works perfectly, except that he never bother to learn the Zlovian language, so when someone challenges him in their native tongue, he is revealed as an impostor. He runs off, pursued by a horde of Zlovians. He ducks into the radio room and doses the unsuspecting Zlovian radio man with the antidote — which turns him human — so the other Zlovian capture him, allowing Tommy to escape to Planeteer headquarters and save the day.

In other words, the Bio Serum antidote doesn’t so much revert the human-transformed-to-Zlovian back to human as it turns any Zlovian into a human. It’s not really an antidote; it’s another Bio Serum in its own right. This sets up a bunch of questions and ideas:
Does it change every Zlovian into the same person (apparently not, or the Zlovian would have turned into Tommy Tomorrow). If someone uses the serum more than once, does it turn them into the same human/Zlovian every time? Upon regaining his humanity, will Tommy still have his appendectomy scar, or will he have his appendix back?
If I were writing a Tommy Tomorrow tale, I would used the bio serums to set up a whole Plain-Belly Sneetches/Star-Belly Sneetches storyline.

Other Thoughts:
1. The weakness of impervium? Plain water.
2. I hope they made more than one dose of antidote.
3. I love the vaguely Eastern European sounding names of the aliens: the “Zlovians.” This was written in the middle of the Cold War, after all.
4. It took Tommy several minutes to turn into a Zlovian, but only took the Zlovian a second or two to turn human?
5. Lack of knowledge of the Zlovian language is what got Tommy in trouble, but the first thing out of the transformed Zlovian’s mouth is English?
6. Was the Zlovian-transformed-into-human killed by his fellow aliens, or was he rescued when the Planeteers rescued the human prisoners from the Zlovian ship? Is he, now, living amongst us, plotting revenge?

Action Comics #222 (November 1956). “The Creature from Outer Space” by Otto Binder and Jim Mooney

Glad I skipped those classes on pathology and germ theory so I could focus on the treatment and identification of the undead. I wonder if Koch’s postulates apply to vampirism?

scene from Spine-Tingling Tales #4

Emma Frost tries to get into Wolverine’s mind, but as she quickly learns, it is possessed by a bevy of demons¹. The results are predictable².

Image from Wolverine #6 by Jason Aaron and Daniel Acuña.

1. What is the proper collective noun for a group of demons?
2. Or at least predictable if you’ve read the title of the post.

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed emma frost wolverine

A very low scoring week. Cyndi, Gleb, and Steve led with 4 points. Seven other people earned 1 point. Everyone else got nada.

Overall, Jamie Pt remains in the lead with 72 points. Gleb leaps into second with 67 points. Corien and Forny drop to third with 66 points each. Tippi falls to fifth with 65 points. If your score is 54 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

A cleverly set up episode of House, with an interesting medical mystery — though the medical conclusion was less satisfying.

I

Darrien, a friend of Thirteen from prison, knocks on her door late at night. She’s been stabbed in the belly and wants Thirteen to fix her up while promising not to take her to the hospital. Thirteen reluctantly agrees and carefully explores Darrien’s wound, declaring that the bowel is fine, however the liver has been nicked — but has clotted off, so blood loss should not be an issue. However, when she’s rechecking Darrien’s vitals, she discovers that there is no detectable blood pressure or pulse in her left arm, though her right arm is fine. Thirteen calls Chase and has him bring a portable ultrasound machine from the hospital because she is worried the patient may have an aortic arch aneurysm. The ultrasound shows no aneurysm, and Chase wonders if Darrien may have clotted off the blood supply to the left arm. They take a close look at the arm blood vessels vessels and and find some sort of mass in the axilla (arm pit), possibly a lipoma (a fatty lump) that is pinching off the blood flow to the arm. They stick a needle in the mass to drain it, but instead of fat, they drain syringe after syringe of blood. Chase suspects the excess bleeding may be a result of the patient’s drug use, her hepatitis C, or exposure to toxins. Thirteen believes that Darrien depleted all her clotting factors dealing with the stab wound, so has none left for the cyst in the arm. She sends Chase out to pick up some IV clotting factor.

While Chase is gone, Darrien begins to hallucinate. This is a sign that she there may be bleeding in her brain. Thirteen wants to give more clotting factor while Chase wants to take Darrien to the hospital. After a brief scuffle, Chase wins and they take Darrien to Princeton Plainsboro, but she falls unconscious along the way. Once there, they obtain a head CT, which shows no bleeding in the brain. Puzzled, they call House who points out that they’re making assumptions about how long Darrien has been abusing drugs and had hepatitis C. Looking back through newspaper records, Thirteen is able to discover that Darrien has had hepatitis for no more than three years, but because she received chronic hepatitis C treatments with interferon while she was in jail, her presentation must have made it appear she had it longer. Thirteen and Chase finally deduce that in addition to the hepatitis C, Darrien must have had a second infection with the parasite Entamoeba. The amoeba had formed an abscess in her liver and thus when her liver was injured in the stabbing, it released the parasite back into her bloodstream which led to her other symptoms. Thirteen and Chase give Darrien some metronidazole and she comes out of her coma.

II

Meanwhile, House has discovered that all the rats given the experimental drug he’s been using have died of cancer. He CTs his leg and finds some suspicious masses. House then decides to remove his tumors himself, but it turns out to be more difficult than he anticipated. He is forced to call Cuddy for help and she takes him to Princeton Plainboro where he eventually requires surgery.

III
Taub has been sleeping with the one of the nurses and she is now pregnant. He is unsure how to proceed, so he and Taub head to strip bar, where Taub ultimately finds himself thrown out and then nearly shot as a stalker.

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

This is another one of those episodes where the final diagnosis doesn’t really explain all the symptoms. The excess bleeding in the arm cyst – and was that a cyst or a lipoma or what? – was that caused by “depletion of clotting factors” (however unlikely that may be) or by the amoebas. The hallucinations and the coma, was that the amoebas again? You can certainly get amoeba problems in the brain, but not so quickly after exposure.

Thirteen is way off about hepatitis C. Chronic is defined as 6 months, not 10 years (or even three years). Interferon is given for chronic infections, but is also given more commonly for acute infections as well now.

Sure, hallucinations could be a sign of bleeding in the brain – through there should be other noticeable neurological signs as well – but what about being caused by blood loss? Darrien may not have signs of internal bleeding, but Thirteen has no idea how much blood she lost before she showed up at her apartment.

Lipomas aren’t full of liquid fat, they’re full of solid fat, so they’re nothing you can drain with a syringe. They’re quite…chunky.

If Thirteen knew Darrien had hepatitis C, she should probably have washed off all the blood dripping from that one hand.

Intravenous clotting factors aren’t something you can just call into the neighborhood pharmacy and pick up. Institutional use only.

This week’s medical mystery was interesting — first the bleeding patient lurching down the hall — and the reveal of the lack of blood flow in the left arm. I give it an A-. The final solution, while clever, didn’t really fit the symptoms well: C-. The medicine was sloppy, some of which I can explain away as apartment-based-emergency-medicine, but you can’t excuse poor basic medical knowledge. It earns another C-. The soap opera was good on many levels this week, from House/Wilson and House/Cuddy (and House/Rachel) to Chase/Thirteen and especially Taub/Foreman. I give it an A.

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

The penultimate House Challenge scores for the season have been posted.

Melvin Mouse is depressed and unhappy with who he is. He decides to talk with Peter Porkchops — who’s always happy — and learn his secret. Several extraneous panels later, we discover the “Secret of the Happy Pig” (which sounds like a Three Investigators mystery): Be Yourself.

Click on the image for the full ad

Of course, this advice won’t do much good if Melvin doesn’t like who he is — which seems to be the situation in panel one. Maybe he would be better served with some counseling and possibly an appropriate prescription.

Peter stands up to Wolfie making sure everyone gets credit for the party. How exactly is he being like Wolfie “in more ways than one”? By standing up for himself? It seems to be every other animal is hopelessly meek.

This is one of the PSAs that was popular enough to be published twice and can be found in both April 1958 and January 1962 DC Comics. Positive reinforcement for the readers, likely. The script is by Jack Schiff with art by Rube Grossman.

More PSAs

Tags: comics psa peter porkchops melvin mouse jack schiff rube grossman

Hawkeye: Blindspot #4
Jim McCann, writer
Paco Diaz, penciler

Spoiler Warning! Read Hawkeye: Blindspot before continuing
(I’d recommend the entire series, but at least issue #4).

It may seem like I’m enjoy picking on Jim McCann, but that’s not true. He writes thoroughly enjoyable superhero comics, and I appreciate the way he frequently throws in good medical scenes — even if he’s been known to get tripped up by the little details. Like in Hawkeye: Blindspot #4.

The occipital lobe, the rearmost area of the brain, contains the visual cortex, where the processing of the sense of sight occurs. An injury to this area can lead to visual impairment up to complete blindness. The brain isn’t particularly good at healing itself, so brain injuries tend to be long lasting if not outright permanent.

First off, the idea of using Pym particles to reduce the swelling in the brain is pure medical genius in the way that only comic books can pull off.

Now, moving on to the actual treatment:

Stem cells are as good an idea as any to repair brain damage — in fact, they’re an entirely reasonable idea. Being able to grow new brain cells would go a long way toward correcting brain damage. Unfortunately, Stark’s plan has no chance of working because they’re using hematopoietic stem cells. These are cells that are found in the bone marrow and are used by the body to grow new blood cells. That’s what they do: create blood cells. It’s in the name: hemato – (blood) – poiesis – (formation). So unless there’s a problem with blood cells, hematopoietic stem cells aren’t going to do much good (but it’s why they’re useful in the treatment of diseases of the blood, like leukemia). Hawkeye needs stem cells that can grow brain tissue (such as pluripotent stem cells — cells that can be used to form any cell type) not stem cells limited to just blood cells.

Returning to Earth after a long mission in space, Tommy Tomorrow notices that everything he looks at is surrounded by rainbow rings. He is examined by the doctor at the Planeteers home base and is diagnosed with Space Fever.

I. Symptoms of Space Fever:
Rainbow rings
Dizziness
Ennui
You’ll notice one symptom conspicuously missing: Fever. (I don’t name these futuristic diseases, I just report on them.)

II. The Cure for Space Fever
Simple, drink milk every hour for three days. Seriously. (Apparently sleep deprivation is not a concern.)
Run out of fresh milk? No problem, as Tommy discovers other fluids will work in a pinch:
Condensed milk
Alien cow milk
Cactus sap

III. Contagious?
Apparently not, as Tommy returns to duty immediately after diagnosis, potentially exposing many others to his fever.

IV. Extra Credit
Compare and contrast Space Fever to Space Fatigue

All images are from Action Comics #229 “The Great Milky Way Hunt”, by Otto Binder and Jim Mooney

The final week of the challenge, and seven people chose the correct diagnosis. There were several “almost correct” diagnoses that also scored points. For this week, Bhetti leads with 13 points, and Adriana, Akshay, Amr, JenJen, Joe, and Mac all scored 12 points.

Overall, Jamie Pt finished the season at #1, and even padded the lead a little. Here’s the top 10 overall:

If you scored 55 or more points, then you finished in the top 10%. Congratulations!

Click here to see the full scoreboard.

The final episode of an unsatisfying season of House was — appropriately enough — unsatisfying. The story, both medical and soap opera, had potential, but it was like everyone gave up two-thirds of the way through.

Afsoun Hamidi, a famous performance artist, is in the middle of an exhibition when she collapses. She is admitted to House’s team at Princeton Plainsboro with arrhythmia, a high hematocrit (too many red blood cells), and “inconsistent RR variability” (a measure of the difference between heart beats). Foreman also thinks that she is crazy and he wants to do a functional MRI to confirm this, but House shoots him down. Other possible diagnoses are an allergic reaction to the paint thinner used in the performance art, or carbon monoxide poisoning from a nearby space heater. House favors the latter and has Afsoun placed in a hyperbaric chamber. Once inside, she becomes sick and vomits. Thirteen suspects infection, but House has caught on to the fact that Afsoun is secretly videotaping everything to make a new piece of performance art.

Chase informs House that Afsoun had a pancreatic cyst that he drained. According to House, the differential now consists of a Coxsackie B viral infection. He also orders a CT scan to check for gallstones — not that he thinks Afsoun has gallstones — but because he’s giving Foreman a chance to scan the lungs to prove his own theory: that pain thinner fumes are the culprit (not that House thinks Foreman is right — he just wants to be there when he’s proven wrong). Sure enough, the CT of the lungs is negative. During the procedure, Afsoun becomes dizzy, pale, diaphoretic (sweaty), tachycardic (elevated heart rate), and hypotensive (low blood pressure). This leads the team to suspect internal bleeding. A colonoscopy is negative and an abdominal ultrasound is also negative. Foreman becomes suspicious and discovers evidence that Afsoun has been secretly blood doping (injecting herself with her own blood) to manufacture symptoms. He also learns that she has been researching Greg House. All to make a more compelling piece of art.

House confronts Afsoun and she admits her deception. But then she tells him that she is really sick, and challenges him to find here true diagnosis. She tells him that she may make up some symptoms, or hide others — but that’s all part of the game. Much to his team’s dismay, House decides to play along. He starts by ordering blood cultures. When Thirteen and Chase are drawing the blood, Afsoun complains of nausea and back pain. A quick physical exam reveals Grey Turner’s sign (bruising of the flanks — indicative of a particularly nasty pancreatitis). Meanwhile, taking a look at Afsoun’s past exhibitions, House has concluded that she has something fatal. A CT scan of the brain shows a mass. House tells her that he’s won the game: she has primary CNS lymphoma with paraneoplastic syndrome. She confirms that House is right.

A little later, House sees that Afsoun is still in the hospital. He asks why, and she mentions that she’s waiting for the nurse to bring her something for her eczema, which seems to have been worsened because of the paint thinner. Looking at the rash, House realizes that it is not eczema. He also realizes that his previous diagnosis was wrong: Afsoun actually has Wegener’s granulomatosis. She is offered radiation therapy and/or steroids for treatment. She initially declines the radiation therapy for fear of mental decline, but is ultimately convinced by Thirteen and her assistant to go for the radiation treatment — and that life may be more important than art.

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

As mentioned numerous times before: it’s irresponsible and unprofessional to treat cancer without a definitive biopsy. It’s one thing to accept that from House, but from another doctor at another hospital?

Radiation is not a first-line therapy for Wegener’s granulomatosis. It’s not even a second- or third-line therapy.

Pallor, diaphoresis, tachycardia, hypotension are all signs of an acute anemia (i.e. blood loss) – which they then tried to explain away as a return to her normal state from the increased hematocrit from blood doping. Nonsense. First, the return to her normal state would be a gradual process, not an acute one, so would not trigger these symptoms. Second, her normal state whould be normocythemic (normal blood counts) not anemic (and certainly not acutely anemic), so that explanation doesn’t pass the common sense test.

“Arrythmia” is a vague term. It’s something you’d find in a general review of a topic (such as “Symptoms associated with blood doping”). A doctor of the caliber of House or his team (or frankly any competent cardiologist or generalist) would be specific about what type of arrhythmia it is. Tachycardia? Bradycardia? PSVT? PVCs? WPW? Afib? VFib? Vtach? Torsades? Each has different causes and different treatments.

Once again, a good physical exam on admission would have found several symptoms earlier: the bruising and the rash. A really good physical exam would have found the injection marks.

There are causes of pancreatic cysts other than acute pancreatitis.

A simple blood test can easily confirm carbon monoxide poisoning.
If it was carbon monoxide poisoning, why wasn’t anyone else at the gallery, at least her assistant, also having symptoms? At least headaches?

Coxsackie B virus doesn’t fit her symptoms at all.

If you’re suspecting internal bleeding, why not perform a quick CT — especially since she’s already in the CT machine?

This week’s medical mystery was moderately interesting, but didn’t sustain interest even after it became a game (not that it mattered, since despite threats, she didn’t lie about any symptoms). I give it a B-. The final solution was unimpressive and earns a C. The medicine was superficial and sloppy, and was driven by the plot, not the other way around. It deserves a measly C-. The soap opera was fair, but could have been so much better. The flash forward sequences held a lot of promise — promise that was never really fulfilled. I give it a B.

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

The final scores for this season’s House Challenge have been posted. Thanks to all who played.

Tags: television medicine house art carbon monoxide lymphoma wegener’s granulomatosis

When someone has been drugged unconscious, shake them until they wake up.

*Not to be confused with actual medical advice.

From the Congo Bill story in Action Comics #187. It was published in 12/1953, so depending on your point of view, it may or may not be considered Silver Age. For me, the script has the pleasant goofiness of a Silver Age story, so I’m going with that.

More examples of Hot Stuff’s medical mayhem.

When Rogue (here known as “Legacy”) attempts to access Xavier’s psychic powers, the entire mutant enclave suffers for it, in this scene from New Mutants #22 (by Carey and Kurth).

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed age of x rogue

Ran/Rode a Biathalon this morning, and it’s taken me the rest of the day to almost recover.