Polite Dissent

There were enough twists in this episode to redeem an otherwise straightforward hunt-the-serial-killer storyline. Sure, we all knew what was going to happen by the end (turning on his double, amnesia, etc.), but the concept of using an alternate universe analogue as essentially a human bloodhound for himself was clever.

The Plot: Olivia is called in by Broyles to work on a serial killer case, only it turns out it’s a case in the alternate universe and Fauxlivia has asked for their help.

After five years of chasing the murderer, alternate-Fringe have finally learned
his identity, only now they can’t find him. Their solution is to have Olivia cross over with the killer’s double from our universe, hoping he can point out what they might have missed. As it turns out, the killer’s double is a forensic psychiatrist and he is happy to help the FBI on a profiling case, not realizing the true identity of the killer, and the team keeps the secret of the two universes from him. He’s no dummy though, and quickly spots pictures and belongings in the killer’s house that he knows he owns as well, and the Olivias have no choice but to tell him the truth about the second universe.

Word comes down from alternate-Broyles that the killer had kidnapped another victim. While the team deals with this information, the profiler escapes, believing he can track down and stop his other self. Acting like a competent detective for once, Olivia is able to track their whereabouts to an old family farm.

Meanwhile, the killer’s double interrupts his other self in the middle of a murder and tries to help him see the error of his way, but the killer sucker punches him, and soon the double is strapped to a chair and pumped full of sodium pentathol while the killer uses a machine to drain the happy memories from his brain. The Fringe team arrives in time to rescue the victims, and Fauxlivia saves Olivia’s life by shooting the killer when he drew a gun on her. In the end, the killer is dead and his double returns safely to our world –luckily his memories of his time in the alternate universe were drained by the killer’s machine so the secret is safe.

And Walter covers every reflective surface in his lab so he can’t see Peter – and it works – only he can still hear him.

1. Ch-Ch-Ch-Changes
Post-Peter continuity in the Alternate Universe:
Fauxlivia is still with Frank (which makes sense, as there was no Peter to get pregnant by)
Alternate Broyles is still around (which doesn’t make as much sense, since his helping Olivia escape cost him his life, and not Peter)
Meat is readily available now.

2. Led Astray
Multi lead EEG display in the killer’s lab, but there was only one EEG lead, at best.

3. To Tell the Truth
Sodium pentathol is not that powerful a “truth serum,” at the high doses needed to make people with holes-drilled-in-their-head feel comfortable enough to talk that freely to a strange person, they’d either be dead or completely sedated.

4. High Fidelity
As much as Olivia was shown to be a good detective this episode, the alternate-Fringe team was horrible. Did it never occur to them that the killer’s double would see something in the killer’s house to clue him in to the truth? I figured it was going to be a problem the moment they announced their plan.

5. High Fidelity
I liked Walter’s recreation of the classic Maxell ad.

6. Reading Too Much Into It.
The tractor license plate numbers recalled by Olivia were entirely different in the spoken versus closed caption version.

An average track down the serial killer plot helped along by some clever Fringe twists. Still it was neither good enough to loose time from the Doomsday Clock, nor bad enough to advance it.

Tags: television fringe fauxlivia alternate universe serial killer

The scoring this season starts out with a bang, thank to the mention of some old favorites like lupus and MRSA.

As of Week 1, Yerkietleads with 18 points. jwsellers and Nextsundayad are in second with 15 points. Rounding out the top five, mbrigdan is in fourth with 12 points, and Sean McBride is in fifth with 7 points. If you scored 6 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

The first episode of what is likely to be the final season of House is off to a good start. The constraints of practicing medicine in prison focus the usually superficial medicine on the show down to its core elements.

After last season’s finale, House is now in prison for driving his car into Cuddy’s house and then fleeing the country for three months. In a meeting before the parole board, House is informed that due to prison overcrowding, he is due to be released in five days, as long as he can stay out of trouble. What follows is a week in the life of Gregory House, prisoner.

As the week start, we see him in line to receive his daily medication. He’s there not only to receive his Vicodin, but also to make sure his sociopathic roommate takes his medications. He also passes one of his painkillers as a “tax” to the head of the jail’s neo-Nazi gang.

Nick, a fellow prisoner, asks House for some medical advice, but House blows him off. Later in the day, when House is doing his rounds as a janitor, he is in the clinic when the doctors are examining Nick. Noting the joint pain and fever, Dr. Adams is prescribing ceftriaxone for a suspected case of gonorrhea. House jumps in, telling her it isn’t gonorrhea and suggests his thinning eyebrows suggest that Nick has lupus. Dr. Adams points out that he doesn’t have the classic malar rash so it can’t be lupus.

The next day, House checks out Nick himself and finds a rash (which he never describes, so it could be any kind of rash) on his left thigh, but Dr. Adams is unimpressed. Later that day, being jostled into a wall breaks Nick’s arm. Bones that break so easily don’t fit with lupus, so House realizes that cannot be the right diagnosis. During his janitor rounds, he discussed the case with Dr. Adams again. Viral syndrome and MRSA infection (antibiotic resistant Staph infection) are mentioned but quickly discarded. Knowing that Nick is a smoker, House now suspects that he has metastasic lung cancer (lung cancer which has spread to the bones, and bones with cancer break easier than normal bones), but it will take a couple days until an x-ray is available. This doesn’t sit well with House. Through an exceedingly thoroughly lung exam, including auscultation and percussion, he is able to convince Dr Adams that Nick has some sore of lung mass. She doesn’t have access to any stat labs or x-rays, so she decides to run an old fashioned bleeding time test (patients with cancer have blood that clots too easily, so she suspects his wound will clot sooner than expected), but instead of clotting, Nick bleeds profusely from his wound.

By the next day, an x-ray has been obtained but it shows a lipoma (a benign fatty lump) rather than a tumor. Dr. Adams suspects a toxin, but she is caught sharing patient information with House and no longer allowed to discuss cases with him. Later in the day, Nick comes to talk to House again. House tries to blow him off, but in the middle of it, Nick collapses in anaphylactic shock. Luckily, House has a convenient ballpoint pen to perform an emergency tracheotomy and save the patient’s life. House’s suspicions are pointing toward some sort of allergy, probably a food allergy, at this point.

On his final day, House has his Eureka! moment when he sees a prisoner drinking a hot cup of coffee. He realizes that Nick has mastocystosis, which caused an anaphylactic attack when he drank hot coffee. House wants to give some aspirin to Nick in an attempt to induce an anaphylactic attack, which would prove the mastocytosis, but Dr. Adams supervisor won’t allow it. A short while later, House intentionally enrages the neo-Nazis in order to get himself beat up so he would get sent to the clinic (whether the riot that followed was part of his plan or not). Once in the clinic, though he threatened with the loss of his parole, he gets Nick to drink the aspirin. As House is dragged away, despite drinking the aspirin, Nick remains symptom free.

When last we see House, he is locked up in the solitary wing of the prison. A meal tray arrives, along with a note that says, “You were right.”

Non-medical comments:
It was nice to see House act Holmes-ian again — identifying and explaining Adams by her shoes, scarf, locket, etc.
I always knew Urkel would end up in prison.

I don’t have that much negative to say about the medicine this week. I liked the idea of having to make a diagnosis with limited resources, and I think the writers pulled it off better this time than previous attempts (like on the plane). The medicine was relatively logical this time with not many curve balls and zebras thrown in just for sake of it. As usual, major complaints are in red, modest complaints are in blue, and nit-picking ones in green:

There are better blood tests from Mastocytosis than House lets on; for instance, a bone marrow biopsy is a good test. Now that Nick has been stabilized, this is not a situation that needs emergent treatment. He can wait the few days required for definitive testing.
ASA has been known to induce mast cell degranulation – and subsequent anaphylaxis – in patients with mastocytosis, but it’s not reliable enough to use a diagnostic test. A positive test would suggest mastocysotis (or an aspirin allergy), but a negative test wouldn’t rule out the diagnosis.

You can’t differentiate a lipoma on an x-ray. You could see that there were no lung masses, but at best an x-ray would suggest a soft tissue mass. You’d need a CT scan or something similar to identify it as a lipoma.
If it were a lipoma, that would be a tissue mass, not a lung mass, so would not have affected the lung exam. The lung beneath it would still percuss as hollow, not solid.

House specifically asked his friend for his pen, but why? He didn’t use it in his firestarting routine. He seems to only have needed it so he could use it to perform a tracheostomy later.

Bleeding time test is a test primarily for platelet function. I don’t know if it’s ever been tested or is appropriate in cancer patients.

Was Nick’s broken arm/elbow ever treated?

This week’s medical mystery was a little vague and general at first, but picked up as the episode progressed. It would have been a two-minute clinic quickie in previous seasons, but it fit the prison milieu perfectly; I give it an A-. The final solution, though a stretch, fit the scenario and earns a B+. The medicine followed a logical progression for once, and the constraints of being in prison helped rather than hurt. It earns a B. Even though the players were new — except House — the soap opera was well done and earns a B+.

A list of all prior House reviews

This week’s House Challenge scores have been posted.

It’s time once again for the world’s preeminent Hawk-and-Dove-ologist to review a Hawk and Dove comic — this week, Hawk and Dove #2, the second issue of the “New 52″ series.

As the issue begins, a new avatar, Osprey, is introduced. Unfortunately, things aren’t going well for him. He’s been severely beaten and tied to chair. Soon the villain Condor, the Hawk look-alike who showed up in the final panel of last issue, emerges and taunts Osprey. Condor refers to himself as a “self-made man” and tells Osprey that he knows his secrets. He then introduces Osprey to his partner, a young woman. Speaking ritualistic words, she stabs Osprey, killing him, and absorbing all his powers — transforming her into a new “avatar” Swan. Condor and Swan decide now is the perfect time to hunt down Hawk and Dove.

Speaking of Hawk and Dove, they’ve managed to find one of mad scientist/anarchist Alexander Quirk’s secret labs, and are cleaning it out of his “Monsters of Mass Destruction” (i.e. zombies) with a little help from the Washington DC SCU. Both Hawk and Dove allude to the fact that they have plans for later that night, much to the surprise of Dove’s boyfriend Deadman.

As the evening rolls around, Hank grouses about having to get all dressed up in a tuxedo, even if it is for an award dinner in honor of his father. He’s in for a nasty surprise when his father reveals that he invited Hank’s ex-girlfriend, Ren (last seen in Hawk and Dove #28, and since then she seems to have gained six inches — in height as well as in bust), as well. Dawn arrives and everyone settles down to dinner. Ren excuses herself to use the facilities, but when she hasn’t come back in quite some time, Dawn becomes concerned. When she and Hank go to investigate, they sense danger and transform into Hawk and Dove just in time to discover that Condor and Swan have arrived — and taken hostages, including Hank’s father.

Since much of last issue was spent on exposition, this issue is able to focus more on action. Though only the second scene is traditionally “super heroic” in nature, writer Sterling Gates does a good job of keeping the storyline moving briskly. Despite introducing several new concepts (other avatars, “self-made” avatars), he doesn’t allow the story to bog down. Even the awards dinner scenes are interesting, which is more than I can say for any awards dinner I’ve attended.

Rob Liefeld’s art, initially, is improved. He had an inking assist on several of the pages, and there’s no doubt that those pages are better. Unfortunately, the art in the second half of the book really begins to suffer. It is especially unfortunate because almost all of these pages feature little more than conversation, and Liefeld has never been particularly good at the non-super hero scenes. His doesn’t-like-to-draw-backgrounds laziness is back as well. For instance, look at the diners sitting awkwardly at the awards dinner – diners who lack silverware, glasses, or any sort of table decoration. Also take a look at the scene where Judge Hall is kissing Ren’s hand – she’s missing a thumb and maybe a couple of fingers as well. My sense, from talking with friends and reading reviewed online (which, admittedly, is not an unbiased sample), is that Liefeld’s art is scaring away more readers than it is attracting.

On a scale of 1 to 5 deformed Captain Americas, with 1 being good and 5 being execrable, this art on this issue rates 3 deformed Captain Americas, worse than last issue.

Notes:
Hank is right to question Dawn’s fashion sense. That dress she was wearing to the awards dinner – that one with the plunging neckline – is not what one should wear to a Presidential dinner. What happened to the conservatively dressing Dawn from before?
Apparently the avatars are more or less human under their costume, at least that’s what we see with the wounded Osprey. Previously, Hawk and Dove’s quasi-divine nature would show through any damage in their costume (thick hair for Hawk, light for Dawn).
What’s up with Dove and Swan’s capes and the way they stick straight out from the shoulders? They look less like capes and more like Murphy Brown era shoulder pads.
I hope that’s not supposed to be President Obama held hostage in the final panel because it looks nothing like him.

All Previous Hawk and Dove Reviews

Tags: comics hawk dove condor swan sterling gates rob liefeld

Watching the Cardinals/Phillies game. Come back tomorrow.

A decent monster-of-the-week episode of Fringe. There was a little advancement on the Peter end of things, plus a little more history of NüFringe continuity, but still a just slightly better than average episode.

The Plot: An aggressive neurotoxic fungus has been discovered in an old tunnel in Boston. By the time the Fringe Team has been called in, it has killed two twelve year-old boys. The extremely decomposed bodies of the two victims explode in a rain of spores. Walter understands what it happening and contains the explosion just in time. The medical examiners in the morgue aren’t so lucky, though, and die when the second corpse explodes. That brings the total dead to three four. A dead homeless man is found in another tunnel, bringing the total to four five. The fungus is spreading throughout the old tunnels underneath Boston.

The team has discovered a third young boy, Aaron, who was in the first tunnel. Walter learns that Aaron and the fungus have sort of psychic bond. When the FBI tries to kill the fungus it, it affects Aaron. Broyles gives Walter two hours to sever the psychic link, but he is unable to. Luckily, at just the right moment, he learns the fungus is more dependent on the boy that the other way round. He convinces Aaron to let go of the psychic bond, and that allows the Fringe Team to destroy the fungus, yet leaves Aaron unharmed.

After the fungus has been dealt with, Walter and Olivia realize that they’ve both been seeing images of a mysterious man — Peter. Walter sees and hears him through visual and auditory hallucinations, while Olivia sees him in her dreams.

1. More Of A Retcon Than A Reboot
We finally learn the fates of the Peters in the NüFringe continuity, and it’s not all that different from the original continuity. Walter’s Peter died young of an illness, just like what originally happened. Similarly, Walter crossed the barrier between dimensions to rescue a sick alt-Peter. Only, when returning to our world, after falling into the icy lake, Peter died. I guess there was no Observer to rescue them this time.

2. I Was Hoping For A Nosebleed
Interesting “psychic bond” from the fungus:
Tinfoil hats offer no protection (despite numerous independent studies showing otherwise)
It can link to a kid at a lab in Harvard, but not to itself in a Boston morgue, which should be closer.

3. I’m Guessing There’s No OSHA in NüFringe
Whose bright idea was it to send the Fringe Team into the tunnel, any of the three times, without protective gear?The first time, all they knew was that something was in there that could cause rapid decay — but that’s reason enough to be protected. The second and third time it was known what was in there and what it was capable of doing, yet no one thought to wear protective equipment (despite wearing it in the morgue). A little foresight would have prevented Agent Lee from getting trapped.

4. There’s No Percentage In That
What sort of reading is a respiratory rate of 89%. Respiratory rate is a number, not a percentage, and the there is wide variation in what is normal – from person to person, and within the same person from minute to minute. I suspect they meant oxygen saturation (which is a percentage score), not respiratory rate.

5. Leave The Carotid Alone
Just like a shot of adrenalin to the heart is a bad idea – no matter what Pulp Fiction says – a shot of epinephrine (another name for adrenalin) into the carotid artery is just as bad. Just put in the IV, it’ll get there nearly as fast and without the risk.
Walter has some of the worse syringe skills I’ve ever seen – not what you’d expect from a self experimenting junkie. Hideously poor sterile technique as well.

6. I’d Rather A Bottle In Front Of Me
The tools that Walter was using were the proper tools for a frontal lobotomy — at least the “from behind the eye” style that was popular for a brief time (a very brief time, thankfully).

Another episode that was neither good nor bad enough to move the Doomsday Clock. The fungus was suitably creepy, but the lack of common sense shown by the agents time and time again hurt the chances of moving the clock.

Tags: television fringe fungus cordyceps psychic

This week, lectio had the high score with 10 points. Ansa was second with 8. Alex51, Christoph, Indyfrick, and squeaky all tied for third with 7 points.

Overall, Yerkiet retains the lead with 20 points. jwsellers is second with 18 points and Nextsundayad is third with 17 points. mbrigdan is in fourth with 16 points, and numerous players are tied for fifth with 13 points. If you scored 11 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

Hopefully not too many of you found yourself watching Terra Nova instead of House because of the ALCS running late tonight.

Tonight’s episode of House featured House’s return to Princeton Plainsboro Hospital to work under Foreman, the new Dean of Medicine. The social aspects of the episode was good, and the mystery intriguing, but the follow through lacked some luster.

Foreman, now Dean of Medicine at Princeton-Plainsboro Hospital, has arranged for House to get a conditional release from prison. The conditions are fairly simple: House is to break no further laws, is under Foreman’s direction, and is only to be at his apartment or at the hospital. (Or at least, those are all the conditions we know about now…)

Foreman has arranged for House’s release because of a difficult medical case. A young college student was killed in a motorcycle crash and his lungs were donated. Just as the transplant surgeons were ready to implant them into the new patient, the lungs went bad, showing signs of increasing airway resistance. The lungs were then placed in a pristine plexiglass box (seriously, no blood? No fluids?) hooked up to a ventilator. House has twelve hours to find out what’s wrong with the lungs and fix them so that they can still be transplanted. To help him out, he’s given the services of Park, a resident who punched her Neurology attending after he copped a feel.

House and Park meet with the transplant team. Their initial diagnosis is ARDS (acute respiratory distress syndrome), which House discounts as there is no exudates. He suggests ehrlichiosis, but that’s already been tested for and treated, and then suggests cocaine. While the patient’s drug screen was negative, House feels the cocaine ingestion was too recent to have made detectable metabolites in the urine. He and Park search the victim’s bedroom at his parent’s house, but find no evidence of drug use. They do find a new pair of glasses and an admission from the victim’s father that his son had headaches, leading House to a new diagnosis of brain tumor. He and Park get the body from the morgue with the plan of getting an MRI. House notices a bulge in the arm, and now thinks that instead of a brain tumor, the victim had rhabdomyosarcoma (A malignant muscle cancer) and paraneoplastic syndrome.

However, reality — such as it is on this show — is unkind to House. The MRI reveals no tumors, and what he thought was a muscle mass was a clot caused by the intravenous plasma the victim had received in the emergency room. House now suspects that something in the unit of plasma the victim received caused whatever is happening in the lungs. The trouble is that each unit of plasma is made up of donations from a number of donors — twenty-five is the number House throws around. He has six hours to find something in the history of those twenty-five donors that will explain the lungs. Possibilities include peanut allergy, dengue fever, FMF (Familial Mediterranean Fever), malaria, acute alcohol intoxication, or lead poisoning. The latter seems the most likely so he starts chelation therapy on the lungs. At first, they seem to be improving, but then things take a turn for the worse. Park and Foreman are able to correct the vasospasm in the lungs, but not before the right middle lobe dies. House is undeterred; he looks at the dead lobe as some tissue he gets to biopsy for the right answer.

Considering what conditions might cause chelation to go poorly, House considers and discards the diagnoses of sarcoidosis, heavy metal poisoning, and asbestosis before settling on the diagnosis of hemosiderosis (a type of iron overload). Park stains the lung tissue for iron, but instead of the expected metal, she finds white blood cells. To House, this suggests an infection hiding in the lung cells, likely brucellosis. He starts the lungs on antibiotics and IVIG (intravenous immunoglobulin). The treatment doesn’t help, and in fact seems to make the lungs worse. Desperate for ideas, House looks to Park and the transplant surgeon for ideas, but all they can suggest are IgA Nephropathy and lupus. House has his eventual Eureka! moment watching one of the wards celebrate a nurses birthday with cake and candles and realizes that the patient had eosinophilic pneumonitis, and the cigar smoke he was exposed to the night of his death caused his lungs to shut down. The lungs are given radiation treatment and this cures the problem, allowing the lungs to be transplanted.

The medicine was extremely disjointed this episode, jumping almost randomly from diagnosis to diagnosis. Some of this was due to the nature of the patient: lungs in a box, but part of it seemed to be a return to the usual poorly thought out differential diagnosis of prior House episodes. As usual, major complaints are in red, modest complaints are in blue, and nit-picking ones in green:

I admit it’s out of my field, but keeping the lungs alive in a pristine clean box — no blood, no fluids, no drainage, no mess — seemed unrealistic.

Not a medical question per se, but how did House, a convicted felon, manage to retain his medical license?

Radiation for eosinophilic pneumonitis, even in this “every minute counts” scenario? Ridiculous. Radiation therapy, even if it would work for this condition, takes time — more than a single treatment — and has its own set of side effects (radiation pneumonitis, for instance). Why not stick with the corticosteroids, since a transplant patient is likely going to need them for some time?

Would a patient with active angina be a candidate for a lung transplant?

Nitrates don’t cause renal insufficiency.

An iron-stain of the lung tissue incidentally reveals high white cells, but no one follows through with a simple H&E stain to show what types of white cells they are.

I would expect the patient to have an elevated WBC, particularly elevated eosinophils.

The patient had severe enough EP to cause a life threatening reaction to cigar smoke, but had never had symptoms before? Surely he’d been around tobacco smoke before…

This week’s medical mystery offered an intriguing premise, but it failed to live to it’s full potential. Just like last week, I give it the mystery a A-. The final solution was unsatisfying, even if it was more or less almost nearly logical. I give it a C+. Unlike last week’s logical progression of medical diagnoses, this week seemed particularly haphazard, and this was a case where a consistent logical approach would have been extremely important. It earns a weak C. I enjoyed the soap opera this week, particularly the scenes with Foreman (but lose the ’stache), Park, and especially Wilson. I give it an A-.

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

This week’s House Challenge scores have been posted.

No sir, psychologists agree that you’re full of bunk.

The brain is an extremely specialized organ — in other words, different parts of it are used for different tasks. One part is used for reading, another for writing, a third for short term memory, yet another for hearing, and so on. So while it is true that only a relatively small portion of the human brain is in use at any one time — or at any one task — over the course of a day, all of the brain is used. There is no dormant 90%.

Also, there already is a term for someone who has all of their brain activated at once: an epileptic.

As a final side note, the brain is full of billions of cells, no millions.

scene from Strange Adventures #69, “The Man with Four Minds,” by Edmond Hamilton and Carmine Infantino.

A fairly light episode that clarifies some parts of NüFringe, particularly the Cortexiphan trials. Plus, the full return of Peter.

The Plot: Olivia is awakened one morning by a strange blue energy apparition. She notices that the apparition draws metal objects nearer, but she misses the strange effect it has on the flow of time. She is burned on the arm when she comes into contact with it.

Olivia reports what happened to Walter at his lab, and he sends her and Astrid back to the apartment to get some more readings. Watching over the video link from back at the lab, Walter witnesses another materialization of the apparition, only he sees the events before they actually occur. Talking with Olivia later, Walter tells her that the phenomenon reminded him of one of her fellow Cortexiphan subjects, a boy who had the ability to astral project, but also had some magnetism-related side effects. Olivia looks over the Cortexiphan trial notes, now held by Nina Sharp over at Maxiumum Dynamics. From these notes, they learn the subject’s name, Cameron James, and where to find him.

Olivia and Walter head to New York City to talk to Cameron, but he isn’t at his apartment when they arrive; they’re told by a nosy neighbor that he’ll be back in the morning. She and Walter get rooms a hotel, but Walter freaks out with an attack of mysophobia and the two of them end up enjoying late night rootbeer floats at a nearby restaurant. While there, the apparition manifests again, bigger than before, and doesn’t fade away until it disrupts traffic and is hit by a car.

The next morning, Olivia manages to track down Cameron, but he insists he has nothing to do with the strange occurrences. While talking with him in his apartment building’s lobby, the phenomenon occurs again, but Cameron is able to drive it away using what little remains of his Cortexiphan powers (side effects, at this point really). Walter devises a plan to use Cameron’s abilities and a large chunk of New York’s power grid to destroy the apparition once and for all. The energy apparition appears again, and Walter’s plan seems to be working – but then Olivia sees the face and body of Peter materialize in the energy. She stops Cameron and the apparition disappears – but then Peter suddenly surfaces at Reiden Lake and is rescued by two fisherman. A short time later, the Fringe Team arrives at the hospital where Peter is taken. Broyles is understandably concerned that this unknown person knows so much about Fringe personnel and history. Olivia walks into Peter’s room and he is clearly delighted to see her, but she still has no memory of him.

1. Fallout, Boy?
A rad is an all but abandoned scientific unit that measures absorbed radiation. There is a lot of math in figuring out equivalent doses, depending among other things on the material involved, but two rads is roughly the same dose of radiation from twenty chest x-rays, a CT of the brain, or a third of a CT scan of the chest.

2. Needed Better Career Counseling
If Cameron becomes magnetic when anxious, then why drive a truck for a living? There’s a great deal of metal in vehicles, and you’d think driving a truck in big city traffic would get quite anxious.

3. Amalgamated
Dental fillings aren’t particularly magnetic. By the time Cameron was generating enough of a magnetic field to affect the fillings, surely there’d be a noticeable effect on the silverware and probaly the pots and pans in the kitchen as well, if not more.

4. NüFringe Revelations
Changes over past Fringe Continuity:
The ethical fallout from the Cortexiphan trials has not occurred in NüFringe. Knows nothing of any of the other Cortexiphan .
Olivia has shown no Cortexiphan related powers as an adult.
Nina and Walter have quite an antagonistic relationship while Nina and Olivia seem to share a more maternal/child bond.
Walter mentions that his wife Elizabeth committed suicide after the death of “our Peter” — suggesting that she died before Walter crossed over to get the alternate Peter.

5. What’s In A Name?
“Cameron James” — really? Why not also have Spielberg Steven, Polanski Roman, or (for an almost believable name) Lucas George?

A fairly shallow episode, plot-wise, but I enjoyed the new Cortexiphan revelations and the return of Peter — in an almost logical manner, at least from a Fringe point of view — so the Fringe Doomsday Clock will move back one minute to 11:52.

Tags: television fringe cortexiphan peter astral projection reiden lake

This week, Ash88 had the high score with 8 points. Ender2003 was second with 7. Cyndi, Harvey, rileyjo, and Silvina all tied for third with 6 points.

Overall, Yerkiet stays in the lead with 20 points. Harvey and jwsellers are tied for second with 18 points. Nextsundayad drops to fourth with 17 points. mbrigdan and Ash88 are in fifth with 16 points. If you scored 13 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

An average, at best, episode of House tonight. You’ll notice I throw around that phrase a lot tonight: “Average, at best.”

Benjamin, a once rich man who now gives all of his money away, collapses after leaving a million dollar donation to a job skills clinic. He is admitted to House’s team, mostly, House admits, because he is rich. Park is unimpressed with the case and feels Benjamin was just dehydrated. She is even more unimpressed when Dr. Adams, the doctor House got fired from the prison clinic, joins the team. Adams suggests cardiomyopathy as a possible cause. An echocardiogram is checked and it shows nothing wrong with the heart. Along the way, a head CT is checked to rule out a subdural hemorrhage, though it was never mentioned in the differential (pay attention, this will become important later). Park suspects Benjamin’s extreme altruism is a symptom of neurological disease, but Adams disagrees. An electromyogram is tested (because apparently muscle tone goes along with charitable impulses), but it is also normal. Just as he is ready to be discharged, Benjamin complains of feeling “funny” and develops tachycardia (an unnaturally rapid heart rate) that is corrected with the administration of adenosine.

The differential diagnosis now consists of long QT syndrome (an inherited heart condition that can lead to life-threatening arrhythmias) and Whipple’s disease (an intestinal malabsorption syndrome). While undergoing another cardiac test, Benjamin develops severe hand tremors (ridiculously severe — I thought he was having a tonic-clonic seizure. And, though mentioned repeatedly, these tremors were never seen again.) With symptoms of arrhythmia, fainting, muscle tremors and (possibly) mental status changes, the differential diagnosis now consists of drug abuse, polyarteritis nodosa, or echovirus infection. The latter seems the most likely, so Benjamin is started on pleconaril, an antiviral active against echoviruses.

House thinks Benjamin is cured, but then he hears that his patient has volunteered to donate a kidney to one of Wilson’s patients. To House, this means that Benjamin’s condition has not improved and it must not have been echovirus. Whipple’s disease now seems the most likely cause, but all the tests including EGD and DNA testing are negative.

With no proof of anything seriously wrong, Benjamin is wheeled into surgery, but his heart rate spikes and blood pressure drops so the surgery is called off. The team now considers a spider-bite (no specific spider species is mentioned) or LCDD (light chain deposition disease), and Adams wants him started on blood thinners for the tachycardia. Foreman shows up and accuses House of doping the patient with some drug to cause his symptoms, but House denies it — to Foreman, anyway — he admits it to the rest of the team.

Back to the symptoms of arrhythmia, tremor, and mental changes, the team now suggests Graves disease, or some other form of “thyroid disease,” Coxsackie B virus or porphyria. (Why weren’t these mentioned in the original differential diagnoses for the same symptoms? They should have been.) The patient is started on hematin to treat the presumed porphyria. Meanwhile, House has his Eureka! moment of the week when discussing the case with Wilson. It seems Benjamin has Plummer’s Disease — a single thyroid nodule that has managed to pump out enough thyroid hormone to cause behavioral symptoms and syncope, but yet remain undetectable in thyroid tests. Benjamin’s condition worsened when he received iodine based contrast for the head CT, which caused thyrotoxicosis (high levels of thyroid hormones in the blood causing hyperthyroid symptoms). After surgical removal of the nodule, Benjamin is back to normal, losing most, if not all, of his altruistic feelings along the way.

I already mentioned some of my concerns above: the miraculous untestable thyroid nodule that causes personality changes, the poorly explained need for EMG testing , and the only mentioned after-the-fact need for a head CT though it was useful for nothing on the differential diagnosis. Here are a handful more (as usual, major complaints are in red, modest complaints are in blue, and nit-picking ones in green):

In referring to the diagnosis of Whipple’s disease at one point, Adams states that it should have improved since the patient had already been on antibiotics.
No, the patient was on an antiviral, not an antibiotic (which is antibacterial). Frankly, that’s a mistake a first year medical student wouldn’t make.
Even if she had been right, Whipple’s takes a year of antibiotics to treat. Do you really think a day or two is going to make that much difference?

I know I’ve mentioned it before, but this episode really highlighted how poorly this show actually understands what a differential diagnosis is, despite it being a major part of every episode. When creating a differential diagnosis, you list every possible diagnosis that could explain the patient’s symptoms, then you run tests or elucidate a better history so the long list can be narrowed down to a shorter one and then finally to the correct diagnosis. If you’re introducing entirely new diagnoses for the same symptoms, then you’re doing it wrong.

Tachycardia simply means an elevated heart rate. There are many causes of tachycardia, but it seems that Benjamin has SVT, since it responds to adenosine. This is not a rhythm that requires blood thinners.

Whipple’s disease is one of the main diagnoses? Really? Where’s the abdominal and bowel symptoms you’d expect? In other words, throw out all the half-dozen expected symptoms and shoe horn in several one-in-a-million-cases symptoms. I know this happens every week on House, but this episode was particularly egregious.
Repeat with spider-bite, echovirus, polyarteritis, porphyria, and most of the other diagnoses mentioned this week.

This week’s medical mystery was nothing special. In the 100+ episodes of House, how many times has collapse been the initial mystery? A dozen? Two dozen? I know they lampshaded it, but that still doesn’t change the fact that the mystery was average, at best: C-. The final solution was quite a stretch requiring several unlikely coincidences: a nodule strong enough to cause personality changes, but not be detectable? check! An unneeded test that fits no suggested diagnosis that worsened the symptoms? check! The final diagnosis earns another C-. The medicine this week was poor. Zebras were chased left and right while ignoring more likely more common diagnoses. I give it a D. The soap opera had some good moments this week, but for most of the show was barely above average with 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.

Binky and his outrageously attired younger brother Allergy are back in this public service ad, which really hearkens back to a bygone era when the kids plead their case in front of the Neighborhood Council.

Click on the image for the full ad

If nothing else, this ad shows that peer pressure works on adults too. “C’mon, Mr. Jones, you know you want to let the kids play basketball. All the cool neighbors are doing it…”

I think Mr. Jones acquiesces just so Allergy and his hideous bowtie will get out of his face. Perspective or not, it looks like Allergy has a head twice the size of Mr. Jones.

This is one of the rare PSA titles that doesn’t end in an exclamation point.

This PSA can be found in DC Comics from March 1953. The script, like most of DC’s PSAs is by Jack Schiff. Frequent collaborator Win Mortimer provides the art.

More PSAs

Tags: comics psa neighbor binky allergy jack schiff win mortimer

In order to be proclaimed “Crimeteer Chief” of the far off planet of Zarria, Zunial travels to Earth to kill Superman. His first few attempts are laughable, and Superman just shrugs them off. Eventually, though, Zunial hooks up kryptonite to a radio tower and somehow broadcasts kryptonite into Superman, killing him.

Zunial returns to his home planet with Superman’s body to prove to the rest of the criminals there that he killed Superman. A quick scan by their life detection rays confirms that Superman is dead.

Luckily, there is a Superman robot on Zarria (the one Zunial used for practice) and he invents a machine that sucks the radio waves out of Superman. No, not the kryptonite itself, just the radio waves — the waves that somehow remained in his body — but the effect is the same, and Superman is brought back to life. Without any more kryptonite, Zunial is caught and Superman returns to Earth in much better shape than when he left it.

In this scene from Hondo City Justice (from Judge Dredd Megazine), Inspector Inaba gets taken out by her mind-controlled trainee, Cadet Judge Asahara.

Later, Cadet Asahara suffers her own pyschic nosebleed when taking on the head villain.

Maxwell Lord is back with a psychic nosebleed, but this time he’s immortalized in plastic as psychic nosebleeds emerge in a new medium: Heroclix.

It’s United Nations Day! If you’re a long time reader here, you probably recall that the United Nations was one of the favorite topics of DC Comics’ public service ad program. What you may not realize is how many United Nations PSAs they published.

In honor of the day, here’s a sampling of DC Comics’ United Nations PSAs (click on the image for more information about that PSA):

The more I think about it, for all intents and purposes, Jor-El was a mad scientist. He espoused scientific theories well outside the accepted norm and performed numerous unauthorized scientific experiments of questionable ethics.

Superman #83 starts with Jor-El inventing a longevity serum. To test it, he proceeds straight to animal trials — well, animal trial, really. He only tests it on one animal. Now, he doesn’t start small and test it on a rat, monkey, or even a guinea pig — but instead he heads out to a nearby Kryptonian nature preserve and elects to test his serum on a Snagriff, a large dragon-like creature¹. Almost immediately, he notices side effects — the Snagriff’s hide turns metallic and it starts eating all the metal in sight. The creature escapes Jor-El’s lab and runs rampant through the city. Finally, Jor-El captures it and maroons it on one of Krypton’s moons² — but a metallic one, so at least it has something to eat.

When Krypton explodes, the Snagriff is hurtled into space, where — of course — it eventually lands on Earth^{3, 4}. Immediately, the creature starts eating all the metal it can find. The police and army try to stop it, but they have no success. This is a Kryptonian creature on Earth after all, so it has all the standard Kryptonian powers including invulnerability and heat vision. Superman intervenes, but even he has a tough time battling the Snagriff. Things go from bad to worse when an alarmed scientist informs Superman that the monster has just eaten six nuclear bombs. Superman tries a different tactic now. He stretches his cape until it is large enough to contain the Snagriff⁵. He then ensnares the creature in his cape, and flies it up into outer space, where it explodes harmlessly, the nuclear explosion contained by Superman’s cape.

Notes:
1. It’s not clear what Jor-El’s experimental plan was, or if he even had one. Was he just going to watch the Snagriff until it died – or didn’t die – of old age?
2. The KSPCA has a long file on Jor-El.
3. Why do all things Kryptonian end up on Earth?
4. At least this is proof the longevity serum worked – the Snagriff lived long enough to travel from Krypton to Earth. And the serum apparently protected him from the rigors of travel through space as well.
5. No, I have no idea how he was able to stretch out his cape so large, and then unstretch it later.

Xylazine is a real drug — an animal tranquilizer. If memory serves, Voodoo writer Ron Marz raises horses, so it makes sense that he’d be familiar with the medication, and it would also explain the reference to Clydesdales (as opposed to the more common “elephant” when animal tranquilizers are discussed).

It does raise a question, though. Why would they expect Xylazine (or any other human or veterinary drug) to work on an alien? In the case of Xylazine, it targets a very specific receptor, the α2-adrenergic receptor, so unless the alien has an identical receptor used for the same purpose, the drug isn’t going to work. (This isn’t a problem unique to Voodoo, I’ve seen it in numerous super-hero and sci-fi stories.)

Back to the scene pictured: Since you’re basically just guessing, why choose an animal tranquilizer instead of a human one? Xylazine may work wonders on animals (certain animals, anyway), but it’s not a particularly good human tranquilizer. Since Voodoo looks more human than equine, wouldn’t a drug known to work better in humans be a better guess (or go with ketamine, which works well for both humans and animals).

A couple of scenes form Fear Itself: FF where Sue Storm tries to use her forcefield powers to separate Angir (the Thing) from the enchanted hammer that has taken him over. Her results are less than succesful.

This week, 4287, FlowerPower, and SMEL had the high score with 12 points. Yep, that’s about it.

Overall, Yerkiet stays in the lead with 20 points while Harvey and jwsellers remain tied for second with 18 points. Nextsundayad is tied for fourth with 4287 with 17 points. If have 13 or more points, you are in the top 10%.

Click here to see the full scoreboard.

House acted like a real bastard in tonight’s episode. If you like that, then you’ll probably enjoy it. If you enjoy coherent medicine or decent mysteries, then you’d better just skip it

Local businessman Thad Barton is cleaning up his yard when he suddenly develops micropsia (a condition where everything appears small or far away). He is admitted to House’s service. The initial differential diagnosis includes JBE (Japanese B encephalitis, a vaccine-preventable disease), central serous retinopathy, atropine poisoning, or thyrotoxicosis (high levels of thyroid hormones in the blood causing hyperthyroid symptoms). House decides the latter is the most likely, and is just about to start the patient on PTU (propylthiouracil, a drug used to treat hyperthyroidism) when Barton reports he is no longer seeing things appear small, but now things are appearing larger than they should. To House, this suggests that Barton has Alice in Wonderland Syndrome, which House explains as a type of atypical migraine.

A short time later, Barton develops severe respiratory distress and hemoptysis. Angiography reveals a hemorrhagic site in his left lower lobe. The differential diagnosis now consists of hyperviscosity syndrome (blood that is thicker than normal), Factor V Leiden deficiency (a genetic condition that causes blood to clot more easily), or myelodysplasia. House tells the team to give Barton activated protein C. According to the team, it will cause a life threatening reaction if he has either Leiden or myelodysplasia (but a different life threatening reaction in each case); House realizes this and wants to give it so they can figure out which diagnosis Barton has. However, instead of the expected life threatening complications, he develops a brief episode of itching. Adams now proposes that Barton has cancer caused by HTLV-1 infection, which his late wife also had and it caused her lymphoma. House agrees with her theory and starts the patient on radiation therapy. Unfortunately, during his first radiation treatment, he develops chest tightness and a rising heart rate. Adams thinks he’s having a heart attack, but the troponin (a blood test for heart attacks) and EKG are equivocal (meaning “maybe yes, maybe no”). House wants an echocardiogram on the patient (to look for areas of abnormal heart wall motion, a sign of a past heart attack), but the patient’s heart is beating too rapidly for the test. Adams is able to get a cardiac catheterization which is normal. The team next proceeds to look at an EP study (electrophysiology study, a test of the electrical “wiring” of the heart), but Barton’s blood oxygenation suddenly drops in the middle of the test for no reason.

House consults a neurologist who suggests the patient has normal pressure hydrocephalus. Park disagrees and thinks the symptoms suggest autonomic dysregulation. She wants to do a tilt table test to prove her diagnosis, but the other neurologist tells her that the patient will slip into a coma if he has normal pressure hydrocephalus. Park proceeds with the test anyway, and Barton falls into a coma. House considers this a fluke and never thought the patient had normal pressure hydrocephalus. He now wonders if the patient might have hepatic encephalopathy, but a liver biopsy is normal. His team suggests Eastern equine encephalitis or loa loa disease, but a glance at an orthopedic x-ray gives House his Eureka! moment of the week. He diagnoses the patient with hyperviscosity syndrome caused by the increased number of antibodies in his blood because of his rheumatoid arthritis. A quick plasmapheresis treatment and the patient miraculously wakes up.

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

Another episode where the team goes straight to treating cancer with radiation therapy, without ever confirming the patient has cancer, let alone what type of cancer it is. The situation is even worse in this episode as no HTLV-1 related condition is treated with radiotherapy.

Similarly, House plans on treating the patient with PTU, despite having no proof the patient actually is hyperthyroid – an easy test to check. PTU is not a benign drug.

So, the patients tachycardia makes getting an echocardiogram impossible (reasonable, if the heart is beating too fast, then it’s damn near impossible to get a good reading on the echo), but yet they are still able to perform a cardiac catheterization, where the same issue would apply – even more so because it is an invasive test with definitive risks, unlike echocardiography.
Apparently no one thought to give a medicine to correct the tachycardia.

Lots of handwaving* with this episode:
What caused the oxygen desaturization? (frantic handwaving – thick blood!)
What caused the heart attack> (more handwaving – thick blood!)
What caused the coma? What did it have to do with the tilt table. And why did it miraculously correct with plasmapheresis?
*My term for when the writers try to distract you so you never notice the patient’s symptoms don’t match the diagnosis.

A migraine is just one possible cause of Alice in Wonderland syndrome; there are others.

House is right to belittle Andrews suggestion of normal pressure hydrocephalus – it doesn’t fit the case at all. But then again, Park’s suggestion is no better.

Ironically, between the time this episode was filmed and broadcast, Xigris (Activated Protein C) has been withdrawn from the market.

This week’s medical mystery was modestly interesting, at least compared to last episode. I give it a B. The final solution fit, but was blindingly obvious — at least it would have been, had the writers been playing fair. Holding out the fact that the patient had rheumatoid arthritis — much different than your standard degenerative arthritis — was clearly intentional. The fact that they had to hide this fact that should have been provided from the very beginning shows that they knew how weak the mystery was. I give it a B for realism, but knock it down to a D for cheating. The medicine this week bad. Missing repeated clots and bleeds. Dropping inconvenient symptoms. Radiating the patient. I give it a D+. Without more Wilson, the soap opera never rose above average: 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.