Polite Dissent

An atypical episode of House as it focused on a day in Dr. Cuddy’s life, moving every other character to the background. A change of pace, but a solid and enjoyable show nonetheless.

Cuddy gets up at five AM and starts the day with some yoga. Her daughter Rachel wakes up a little while later, sick, and Cuddy comforts her while getting ready for work. The nanny arrives, and then Lucas, who’d been up all night on a stakeout. He talks her into a quickie before work, but unfortunately he was a little premature in his efforts and she heads off to work unsatisfied.

Cuddy arrives at the hospital at eight and things are already going crazy.

House strolls up to discuss his patient he thought had resistant Staph, and who he wanted to treat by infecting him with malaria.

Cuddy walks off, telling House that she has to finish a proposal before an important 8:30 meeting and there’s a crisis in the pharmacy where some paperwork, and some ephedrine, is missing. Next, there’s a problem in surgery, where one of the surgeons is complaining because House has turned on the air conditioning. She gets the heat turned back on and heads to her meeting.

Meeting Cuddy in the hallway, House informs her that his patient now has boils and a large abscess.

Cuddy hears from the nanny that Rachel is still sick, only now she’s running a fever and vomiting. She finally makes it to her 8:30 appointment with the contract negotiator from AtlanticNet Insurance, the largest insurance company in the area. He and Cuddy have been arguing about a contract for eight months, and today Cuddy lays it all on the line. She agrees to capitated care, but wants a 12% increase in rates. He refuses. She tells him that this is the hospital’s final offer and he has until 3PM to agree, or she will make a public announcement that they are no longer accepting AtlanticNet, and why.

Thirteen and Taub report to House that their patient is now hallucinating and has a falling blood pressure and rising heart rate. They suspect congestive heart failure, but House disagrees, telling them that the patient has [elevator door shuts before we hear the answer].

On the way to the hospital board meeting, Cuddy has a run in with Dr. Thomas, the hospital’s Chief of Surgery. He is seething about House — upset primarily about the fact that he stole Chase back from the surgery department. She heads into the board meeting where the board makes it clear that Cuddy’s job is on the line if she can’t pull off the contract with AtlanticNet.

House skipped clinic again, so Cuddy fills in for him. The patient is an older man with metastatic cancer who wants a prescription for breast milk. He has heard that breast milk can help with his cancer, and wants a prescription so the insurance company will pay for it. She refuses, pointing out that even with a prescription the insurance company won’t pay for it. He accuses her of being in the pocket of the insurance company before insulting her and storming out.

Back at her office, Cuddy finds a lawyer waiting for her. He is representing Martin Acevedo, a man who had his thumb reattached after cutting it off with a saw. He is suing because he didn’t want the thumb reattached — he is poor and that was too expensive — but Chase went ahead and did the surgery anyway. When confronted Chase admits that he did sew the thumb back on even though that was not what the patient wanted because he felt that the reattachment was the best option for the patient medically.

A little while later, Cuddy meets with Gail, the pharmacy tech who stole the ephedrine. She tells Cuddy that it was to help her lose weight and asks Cuddy not to fire her. Cuddy takes a little pity on her and tells Gail that she has to fire her, but she won’t report her to the DEA. She grabs a quick unhealthy lunch from the cafeteria.

House is sitting in Cuddy’s office – in her chair – waiting for her. He tells her that his patient has renal cell cancer (kidney cancer) and he wants to treat with malaria in addition to chemotherapy.

Lucas swings by the office, bringing Cuddy a real lunch. He tells her that Rachel seems to be doing better — she is no longer running a fever — but she has developed a rash. Unfortunately, Lucas accidentally grabbed the nanny’s phone, and turned the ringer off on Cuddy’s phone at home, so there is no way to reach the nanny.

With Lucas’s help, Cuddy tracks down the CEO of AtlanticNet at lunch and confronts him about the contract. He blows her off, telling her he doesn’t care if her PR campaign makes him out to be a rich bastard, as long as he stays rich.

Back at the hospital she meets with the head of the pharmacy and discovers that a lot more ephedrine is missing from the hospital than previously suspected — $50,000 dollars worth — and the thefts have been going on for at least three years. She realizes that Gail has been lying to her and has been stealing the ephedrine to sell to a meth dealer (ephedrine can be used to make methamphetamine)

The negotiator from AtlanticNet returns and offers an 8% increase as their final offer. Cuddy declines, wanting the full 12%.

Now House’s patient has liver failure and needs a transplant.

Three o’clock arrives, and as there have been no new offers from AtlanticNet, Cuddy calls a staff meeting and informs the physicians that the hospital has terminated the contract with the insurer. This causes widespread disbelief and dismay among the staff, as many of them made much of their money from AtlanticNet patients.

Foreman arrives, telling Cuddy that they’ve found a liver, but now there’s another conflict. House wants Chase to do the surgery, but Thomas refuses to put him on the schedule. Foreman needs someone who outranks both House and Thomas to schedule the surgery.

Cuddy meets with Acevedo and his lawyer. She tells them that not only will the hospital fight the lawsuit tooth and nail, but that she wants Acevedo to pay the remaining bill for his care.

Next, Cuddy arrives at the surgical suite and breaks up a brawl between Drs. Chase and Thomas. She then returns to her office and confronts Gail, the recently fired pharmacy tech, about lying to her. Gail freely admits the theft and tells Cuddy she can’t do anything about it because she’ll lie to the DEA, telling them that she did it on House’s orders, and that House and Cuddy were having an affair. Frustrated, Cuddy walks out of her office, telling the staff that she quits. She sits quietly in her car for a few minutes until House arrives. He cheers her up, as only House can, by insulting her, but this is enough to get her to head back into the hospital.

Cuddy confronts Gail again, who once again brags of her theft and her plan to lie to the DEA. Luckily, Cuddy captured it all on one of Lucas’s hidden recording devices. The nanny calls and tells her that Rachel is doing fine. To complete the hat trick, the negotiator from Atlantic Net arrives and tells Cuddy that the insurer has agreed to her 12% proposal. Ecstatic, she informs the board and staff, who share her enthusiasm. Finally, she heads home to Lucas and Rachel after a long, exhausting day at work.

No significant medical complaints, and no grading this week either, as the episode didn’t give me much to work with in that regard. Just a few thoughts and comments:

Though I know nothing of its use in Staph infections or cancer patients, before the advent of penicillin, malaria was used a treatment for syphilis. The malaria gave the patients a high fever — high enough to kill off the syphilis germs — and malaria was curable with quinine.

On one hand, you could argue that Cuddy should have acceded to the patient’s wishes and given him a prescription for breast milk, since, as House said, “it might work.” However, I have to side with Cuddy on this one. First, she’s right: the insurance company will not pay for it, even with a prescription — they’ll consider it an experimental treatment. Second, it’s her signature on the prescription, and she should not write any prescription she is not comfortable signing. Finally, and she should have pushed this part harder, the breast milk is at best a shot in the dark — it’s wishful thinking — and by writing the prescription she would be confirming the patient’s false hope. She handled it well: she was upfront and truthful and told the patient she would not write the prescription. He didn’t like what she said, but he’s free to find a new physician.

Though it was mentioned briefly at the beginning, both Cuddy and the lawyer are glossing over the key fact that the treatment Mr. Acevedo received was not covered by the informed consent he signed. Chase may have done what he thought was best for the patient, but he did it through lying and dishonesty. Sure, Mr. Acevedo kept his thumb, and this will probably restrain the jury’s and judge’s enthusiasm for a large payout, but there is clear written evidence that Chase was deceitful in his treatment of the patient. The hospital’s insurance company will pay this off long before it sees a courtroom. And as for Chase, skipping informed consent or lying on it is a good way to lose a medical license.

Every place I’ve ever worked has a two people count the controlled substances in the pharmacy, just so situations like Gail’s can’t happen. And why does the hospital have so much ephedrine? It’s not that common a drug.

Anyone know what the rules in New Jersey are for surreptitiously recording a conversation? I know in Illinois it needs the consent of both parties involved, but I believe this is the exception, rather than the rule.

Consider this a non-scoring week for the House Challenge. Last week’s scores can be found here.

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

Only four days remain until Christmas, and today’s Advent Calendar Countdown Comic Book Cover is another Golden Age funny animal title. This one features hippos, monkeys, snow, and palm trees.

Funny Picture Stories #4
(Centaur, December 1937)

Click on the cover for larger view

4 Days until Christmas!

Read more…

The criminal who discovered Jor-El’s super-power pills has escaped from prison and rumor has it that he has hidden one last pill somewhere. Superman, Batman, and Robin rush off to capture him before he can reach the pill, but the criminal slips by them. Batwoman (the mini-skirted all-but-incompetent Silver Age Batwoman, not the current one) decides she wants in on the act. She manages to find the villain and grabs his pill before he can swallow it. She then swallows the pill herself — and with her new super-powers — returns the criminal to prison.

Now that Batwoman has super-powers for the next twenty-four hours, how do you think she decides to use them? Stop crime, right? Wrong. She decides she is going to use her super-powers to discover the identities of Batman, Robin, and Superman.

So, not only does Batwoman — an alleged super-hero — not use her new powers to fight crime, but instead she uses them to betray the confidence of other heroes. Nice going.

Batwoman follows Batman and Robin as they drive around Gotham City in the Batmobile. They give her the slip — or at least they think they do — but as soon as they drive into the Batcave, there she is waiting for them. She tells the duo she used her x-ray vision to find the Batcave, and now, based on the mansion above the cave, she knows their identity. Next she sets out to discover Superman’s.

Batwoman catches up with Superman when he is saving a small town from an avalanche. She follows him, hoping he’ll lead her to his secret identity. He tries to scare her away by flying through a lightning storm, walking through an artillery proving ground, and floating over Niagara Falls, but none of it works. Finally, he decides what his only option is to expose her to the thing every woman is scared of: mice.

Superman’s plan works and he sneaks out through the basement, drilling through the ground, making sure to stay below veins of lead-bearing ores, but Batwoman is able to track him by sound. When he emerges from the ground, she tells him that he has fallen into her trap. She’s lured him away from his job for the whole afternoon, and since she saw what block of Metropolis he came from, all she has to do now is find the office in that block where a worker has been missing all afternoon. When she shows up at the Daily Planet, Lois tells her everyone has been there the whole day (but she only mentions Clark, Jimmy, and Perry — so in the Silver Age the Daily Planet apparently only employed four people). At this point, Batwoman’s twenty-four hours of powers are up and she admits defeat in figuring out Superman’s identity — but at least she knows the true identities of Batman and Robin. Not so fast, says Superman:

And just in case you were wondering:

Story from World’s Finest #90 (September/October 1957), by Edmond Hamilton and Dick Sprang

Tags: comics medicine kryptonite superman batman robin batwoman jor-el pills

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I suspect the rescue personnel were a little distracted.

Zombie Terry Long

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

More exciting than the last episode, but the “big surprise” was obvious barely halfway in. Charlie is seriously creepy though.

The Plot: A small town in Pennsylvania has had seven people disappear in the past four months. Peter talks Agent Broyles into letting the Fringe Team investigate because he feels it may be related to Agent Dunham’s disappearance. Walter discovers a strange thick blue liquid at the scene of the latest disappearance, and Dunham realizes that one townsman, Andre Hughes, a retired doctor, was at the scene of several of the disappearances.

Peter and Dunham question Hughes at his home. Olivia thinks she hears someone else in the home, but can’t find anyone. She does find a fairly extensive lab in the house. They bring Hughes down to the Boston FBI office for questioning. He answers their questions, but refuses to give a blood sample. Dunham discovers that Hughes’s wife and infant son died in childbirth nearly twenty years before.

Suspecting foul play, the team exhumes the bodies of Hughes’s wife and son. The wife’s body is brought to Walter’s lab for evaluation but there is no body in the son’s coffin. It looks like something chewed its way in — or out. A small tunnel is found leading out of the grave into the ground.

Walter’s autopsy reveals that the late Mrs. Hughes had lupus, which he claims made it impossible for her to be pregnant. Closer examination reveals that she had been pregnant as there is still a placenta present; however, closer examination of the placenta reveals human DNA plus something else, apparently scorpion and mole rat DNA. Walter hypothesizes that Hughes used his knowledge of biology and genetics to alter his son while he was still in the womb — to make it more likely that he would survive the pregnancy.

Peter and Dunham suspect Hughes’s mutated son is still alive and living in tunnels under the town. They search Hughes’s house once again and find the partially decomposing corpse of a dog hidden behind a wall in the basement. They also find a recent tunnel with a dead — and gnawed — human body. Just as Dunham is telling Peter what she found, something grabs her from behind. Peter chases after her and there is a claustrophobic fight in an underground tunnel between Dunham, Peter, and Hughes’s mutated son. Peter stabs it through the chest. It tries to escape, only to be crushed by car that falls into the collapsing tunnel.

As the episode ends, Peter and Walter head of to go fishing, while Olivia meets with a mysterious man at a bowling alley who seems to know more than he is telling about the strange symptoms she’s been having since her trip to the other world.

1. A Quick Summation
This episode of Fringe = 65% The Lurking Fear + 30% Tremors+ 5% The Big Lebowski

2. A Silver Platter
Has then ever been an episode of Fringe telegraphed more blatantly? Who didn’t realize who the killer was, once Hughes mentioned that wife and infant son died in childbirth? The episode could have been salvaged by a climactic ending, but it instead it was over faster than the big boss fight in Transformers 2.

3. My Arm is Tingling Therefore I Cannot Move It
Walter seems to be confusing a paralytic with an anesthetic. Numbness is the sign of an anesthetic; not being able to move is a sign of a paralytic. I can numb your hand with lidocaine, but you’ll still be able to move it. On the other hand, I can paralyze you with pancuronium and you’ll be unable to move, but still feel everything.

4. Where’s House When You Need Him?
While lupus makes becoming pregnant — and carrying the child to term — very difficult, it does not make it impossible.
I’m impressed that Walter can find a malar rash on the skin of a corpse 17 years dead.

5. Dig Them Up
Since when do they open exhumed caskets in the open air, in public?
I would have like to see the search warrant/court order for the exhumation Exactly what information did they have on Hughes? An extremely vague note that may possibly if-you-squinted-your-eyes-right suggest he might have something to do with the death of his wife? He was seen near 3 of 7 missing persons? He, according to his constitutional rights, refused to give blood? He has a chemistry set?

6. String Him Up
That was a time consuming and elaborate way to hang yourself. Why not just use your shirt? What was that wire rack anyway?

Bad medicine, an unoriginal story, and another chimera as the bad guy all add up to the Doomsday clock moving one minute closer to midnight

Here’s an ad from Action Comics #70 (March 1944) where Superman exhorts his readers to send a dime to help win the fight against infantile paralysis (i.e. polio). This is back when the March of Dimes lived up to its name, and collected dimes to fund polio research.

Click on the image for the full ad

As a added bonus, if you sent your dime in to Superman, you were automatically enrolled in the Supermen of America Club and scored some serious swag including a membership card, certificate, and secret decoder. Best of all, you received an autographed picture of Superman, signed “Clark Kent (Superman)” — which pretty much defeats the whole concept of the secret identity.

Giving credit where credit is due, endemic polio was eradicated from the United States starting with the introduction of the Salk and Sabin polio vaccines in the 1950s — research that was partially funded by the March of Dimes.

More PSAs

Tags: comics medicine psa superman polio march of dimes

Marvel Zombies 4 #1 “Midnight Sons, part 1″
Fred Van Lente, writer
Kev Walker, penciler

Morbius may be a snappy dresser and a brilliant biochemist, but he is clearly clueless about vaccines.

Generally speaking, there are five types of vaccines in common use:

Live attenuated vaccines
These are the only vaccines that could possibly cause a disease — but only certain vaccines, and only in certain rare instances. As the name suggests, these vaccines use live, but weakened, germs. The measles, mumps, and rubella vaccine (MMR) falls in this category. It might cause a slight fever or body aches, but it will not cause measles, mumps or rubella.
The varicella (chicken pox) vaccine is also in this category. One in 20 of the recipients of this vaccine will develop a mild rash (usually 1 or 2 pox near the injection site), and a few children with a compromised immune system have developed a full chicken pox infection after vaccination, but there have been no reported deaths associated with the vaccine (unlike actual chicken pox, which prior to the use of the vaccine, killed about 100 people per year in the US).
The vaccine with the highest risk is the oral polio vaccine (OPV), which reverts to the wild-type fully infectious polio virus in about one in a million recipients. Luckily, the OPV hasn’t been used in the United States in nearly a decade (and realistically, before the vaccine, many more than one in a million children contracted polio).

Killed virus vaccines
These vaccines used dead germs to induce an immune response. Since the germs are dead, they can’t cause a disease. Killed vaccines include polio (the current injectable vaccine, not the oral one), hepatitis A, and the flu.

Subunit vaccines
In these vaccines, only a small part of the infectious organism is used — generally a surface protein. Since the entire organism is not present, there’s no way this type of vaccine can cause an infectious disease. Hepatitis B and the HPV vaccine (Gardasil) are examples of this kind of vaccine.

Similar is the conjugate vaccine. In these vaccines, part of the outer coat of an infectious bacteria is combined with a larger protein to make it more susceptible to the immune system. Again, since only part of the germ is used in the vaccine, it cannot cause disease.

Finally, there’s the toxoid vaccines, which are used to protect against toxins put out by certain bacteria such as Clostridium tetani (tetanus) and Corynebacterium diphtheriae (diptheria). Since no germ is used in the vaccine, there is no zero chance of developing a “full blown” infection.

So out of all the vaccines we routinely give, only two even have the “slight chance” Morbius mentions of causing the actual disease. But even that is overstating it: the varicella vaccine has only been shown to cause full blown chicken pox in immune compromised individuals, and the oral polio vaccine hasn’t been used in the United States since 2000. (And you’ll notice that both those diseases are viral, while Morbius specifically mentions bacteria [never mind, see comment #8 below]).

I hope you’re a better zombie fighter than immunologist, Morbius.

Mike mentioned the Popeye and Environmental Careers comic a few days ago, but it’s not the only career PSA comic featuring the spinach loving sailor. In fact, King Features published fifteen different “Career Educational Comics” in the early ’70s. Sadly, the only one I own is Popeye and Public Service Careers, so that’s going to be this week’s public service comic.

Popeye and Public Service Careers features Popeye and Olive Oyl (both strangely eloquent, if not downright loquacious) telling readers about different careers available for them. The comic is clearly written for the high school student planning for their future. The educational requirements, from high school diploma to an advanced degree, are spelled out explicitly for each career, as are the benefits including vacation, pay, insurance, and retirement. As you would expect from a comic from 1972, there is more than a little implicit sexism in the comic (for example, no female firefighters or college professors, and no male nurses or elementary school teachers).

It’s a hefty comic, 32 pages, that goes into detail on an impressive variety of “public service careers.” It’s a long list of occupations (and I’d argue that calling a few of them “public service” is really stretching the term): police officers, firemen, sanitation workers, civil service workers, public health nurses, sanitarians (environmental engineers, food inspectors, etc), public utility workers, elementary school teachers, secondary school teacher, college professors, librarians, postal workers, lawyers (no, really — lawyers are “public service”), clergymen, city managers, and members of the military.

Tags: comics psa popeye olive oyl public service

In the early ’90s, Marvel Comics (and writer Mark Gruenwald in particular) decided that having one of their flagship characters, Captain America, gain his powers through drugs (in this case, the Super Soldier Serum) was a bad idea — after all, it was the tail end of the “Just Say No” era and drugs (all drugs) were bad. So Gruenwald concocted the Streets of Poison storyline which ended with Captain America undergoing an exchange transfusion, flushing the Super Soldier Serum from his body.

Only an unpowered Captain America wasn’t that interesting a character, so less than a year later Captain America was returned to his Super Soldier Empowered status quo. In the otherwise forgettable Captain America #384 (Captain America fights a giant ice worm in the Arctic), it is revealed that Cap’s Super Soldier Serum has regenerated and he has regained his super-powers. It takes a full page of talking heads to explain to Cap (and readers) what has happened, but this panel — which is nearly Claremontian in its amount of dialogue — sums it all up:

So somehow, over time, the Super Soldier Serum had become a “self-replicating virus.” This means two things: First, Captain America gets his powers back. Second, his powers are no longer due to drugs, but a “virus” and therefore he is no longer a “drug user” (remember, drugs are bad) and should not be censured as such. Just to hammer home the point, a few panels later, Cap says:

I guess there isn’t a lot of comparison between my situation vis-a-vis body altering substances and those who abuse conventional drugs.

(And yes, I realize the idea that a drug could become a virus is ludicrous, and the term “self replicating virus” is a contradiction, but it was how hard Gruenwald worked to dance around the “Captain America is on drugs” conceit that really caught my attention.)

A perfectly serviceable episode of House – for the middle of the season, anyway. As a season finale, it was a bit of a let down (until the last five minutes, that is).

Scott is a 20 year-old who has undergone surgery that cut his corpus callosum (the part of the brain that allows the left and right sides of the brain to communicate) to treat a seizure disorder. The seizures have resolved since the surgery, but he has subsequently developed Alien Hand Syndrome, where he has no control at all over his left hand and it seems to have a mind of its own. He is at a restaurant on a date, complaining of bland food, when his left hand starts throwing rolls at an obnoxious diner at another table. A fight ensues, and before the melee even starts, we notice blood dripping from his eye.

Scott is admitted to House’s service for evaluation of his bloody tears and loss of his sense of taste. The initial differential diagnosis includes autoimmune disease, nasolacrimal tumor, infection, or the common cold. House has Taub and Thirteen search Scott’s apartment and they find mold growing on the ceiling in his bathroom. They decide this is the cause of his symptoms and start him on anti-fungal medication. About this time, Scott has a fight with his girlfriend, his left hand slapping her, and she storms out. He tries to follow her out but finds that he cannot walk. The differential now consists of dehydration or a meningioma (the most common tumor of the central nervous system) — only it’s a special meningioma that is allowing the two sides of the brain to communicate again. Instead of running an MRI or CT scan to look for the tumor, they run a test to see if there is communication between the left and right brain. The test is negative, but House notices that Scott is shivering. He also detects an ammonia scent to his breath and sees a caput medusae on physical exam, all signs of liver failure. House suspects the liver failure is due to sarcoidosis and has the team perform a liver biopsy. While performing the biopsy, Thirteen sees splinter hemorrhages (a sign of trauma or tiny blood clots) under Scott’s fingernails. He then takes a sudden turn for the worse, vomiting blood while his oxygen saturation and blood pressure drop.

The team now decides that Scott has a clotting issue, and start him on heparin (a blood thinner). An echocardiogram is normal, so the heart isn’t the source of the clots. They’ve also run tests for Factor V Leiden, Protein C, and Protein S (all things that can cause a clotting disorder), but they’re also negative. Thirteen now recalls his mention of always being sweaty and wonders if that might be a symptom of whatever disease he has. Cancer is thought to be the most likely, particularly lymphoma or pancreatic cancer. House strongly suspects the latter, even when an MRI of the pancreas is normal. He has Chase perform a new test where scorpion toxin and infrared dye is painted on the pancreas and will light up any cancer cells. There isn’t any sign of cancer, but once again Scott starts to develop a dangerously low blood pressure. House now realizes that the clotting problem is caused by his heart throwing off clots, but only when he slips into an arrhythmia, which he does under stress (like surgery or a biopsy), or every now and then. Sure enough, Chase checks a transesophageal echocardiogram and finds an abnormal rhythm and clots in the left atrial appendage. The heart throwing clots explains most of Scott’s symptoms, but what explains the heart condition? The new differential includes rhabdomyolysis (muscle disease), Graves disease (an autoimmune disease that causes too much thyroid hormone to be produced), and Cushing’s Syndrome (a condition where the body makes too much cortisol, a steroid). The Cushing’s seems the most likely, and a dexamethasone suppression test is ordered. About this time, Scott’s girlfriend returns and points out that his left hand only seemed to get “agitated” when Scott’s deodorant was involved. It turns out to be a special deodorant that Scott has to special order. Taub checks on it, and sure enough, one of the ingredients has been shown in one case to cause a heart condition and therefore this is decided to be the cause of Scott’s problem. End of case. Taub also notes ironically that the chemical has been implicated in seizure disorders, and maybe Scott had not needed the surgery in the first place.

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

Patient has neurological signs (loss of his sense of taste, inability to walk) and they even suspect a brain tumor, yet they never check a CT or MRI of the brain?

The liver failure, particularly the varices and caput medusae, developed way too quickly — or else they’ve been there for a while and the team did a piss-poor physical exam.

It caught my attention when the script was vague about propylene glycol causing “heart problems.” From what I can find, it can cause arrhythmia, particularly bradyarrhthmias (abnormally slow heart rates) and QRS abnormalities. I don’t see any connection between it and atrial fibrillation, the arrhythmia that would cause Scott’s symptoms (again, left unnamed in the script).

The patient is crashing in the OR and no one thinks to look at the cardiac monitors?

I was surprised how quickly the team accepted that propylene glycol caused his problems and just stopped there, other more likely causes left untested for.

While giving blood thinners to someone with a clotting disorder is a good idea, they might want to think twice about giving it to someone with bleeding esophageal varices (at least I assume he has them, that’s the only thing that fits and can explain the vomiting blood).

Chlorotoxin-based (scorpion venom) tumor paint has been used in animal models, but I’m not sure it’s been tested in humans yet. It seems like an extreme step to take though. One of the first things I was taught (and taught loudly) on my surgical rotation was “don’t mess with pancreas” — though the language was more colorful.

So a clot to the brain caused the lack of taste , but what caused the bloody tears?
And don’t tell me “subconjunctival hemorrhage,” that was an embarrassingly bad suggestion of Taub’s.

I like that the writers finally acknowledge that storylines are often built on single case reports (not that there’s necessarily anything wrong with that).

The medical mystery was mediocre, and they never explained one of the opening symptoms. His underlying condition (Alien Hand Syndrome) was more interesting that the mystery: C. The final diagnosis fit the symptoms, or at least the main ones, it just seemed the team accepted that the deodorant caused it too easily. I give it a B. The medicine overall was superficial and rushed, but not horrible. I give it a weak B. The soap opera was the highlight of the show, particularly the end scenes with Cuddy and Wilson and earns the show an A in this regard (though shouldn’t Cuddy have been mad that House lied to the clinic about sleeping with her, and not just yelled at him for discussing her sex-life?).

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

Fantastic Four #561 “The Galactus Engine”
Mark Millar, writer
Brian Hitch, penciler

In battle, Sue Richards disables the future Wolverine by turning his optical nerves invisible, thus rendering him blind…then the Thing clobbers him.

Nice plan, but there’s no way it’s going to work.

As the name suggests, the optic nerve transmits nerve impulses from the back of the eye to the brain. It does not transmit light or images of any sort. Thus turning it invisible would have absolutely no effect on vision. It would be like turning the wiring in a lamp invisible but leaving the bulb alone — the light’s still going to work.

This is the second time I’ve seen this error in a comic book; it must be a more common misconception than I realized.

Other thoughts:
Sue can see when she’s invisible, and her optic nerve is invisible with her, so maybe she should have realized there was a flaw in her plan earlier.
Wolverine, he of the “I can smell force fields” a page earlier, is disabled by losing his vision? He defeated Sebastian Shaw by purposefully fighting him in the dark in another comic published the same month.

Medical errors — and lateness issues — aside, I am thoroughly enjoying the Millar/Hitch run on the Fantastic Four. I think it just hits all my Fantastic Four buttons perfectly.

As Wolverine is distracting (well, “fighting with”) Sebastian Shaw, Charles Xavier tracks down the mysterious Dakken. In reading his mind, he encounters something he was not expecting…which explains the bloody nose (and ears).

It’s not seen in this panel, but Dakken had a similar psychic bleeding problem, so at least Xavier gives as good as he gets.

X-Men Legacy #218 by Mike Carey and Scot Eaton

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed wolverine charles xavier

Ultimate Fantastic Four #59
Joe Pokaski, writer
Tyler Kirkham, penciler

When I read the solicitation for this issue of the Ultimate Fantastic Four, I had high hopes. A Fantastic Voyage style adventure into Sue Storm’s brain? Sounds great! Unfortunately, the book didn’t live up to my expectations. Now don’t get me wrong: it’s not a bad comic — unlike many recent comics it actually advances the plot and has good characterization — but all the same it’s a frustrating comic because it could have been so much now. Plus there’s a handful of questionable medicine.

Sue Storm has been unconscious since using her powers to save New York City from a tsunami wave in Ultimatum #1. Not only did this give her a psychic nosebleed, but it also knocked her into a coma. Not a normal coma, but one that can only be corrected by zapping a specific area of the hindbrain known as the “Omega Synapse” (cue dramatic music) with a laser. Of course, this must done from inside her body. Since Reed Richards is nowhere to be found, Ben Grimm recruits disgraced scientist Dr. Arthur Molekevic (aka the Mole Man) to help him. Together they jerry-rig a space shuttle with a laser and a Pym-particle-based shrinking device, then hop in and begin their voyage.

Grimm and Molekevic start by flying in the mouth and down the trachea, because Molekevic assures Grimm that it is way it’s always done. It’s a little hard to tell it’s the trachea by the art, because it lacks the ring-structure normally seen in the trachea . Frankly, it looks more like the esophagus. Luckily, sensing my confusion, the artist has drawn lots of air lines, so we know it’s the trachea (or else Sue’s inhaling a lot of tiny worms). Plus there’s a caption.

Next, another caption identifies the shuttle as being in the carotid artery, but the dialogue indicates they’re heading toward the heart. If both are true, then that’s a very bass-ackwards way to get to the heart if the ultimate destination is the brain. Another comment a few pages later indicates that they are just then heading out for the carotid, so I think it’s safe to say the caption is wrong (it should probably read pulmonary vein).

Since the shuttle’s in Sue’s circulatory system now, at some point they must have crossed from her airways into her blood vessels, but how or where is never explained (or even mentioned). This is probably just the doctor/sci-fi geek in me talking, but I would have really liked to know how they did it. Personally, I’m assuming they crossed over in the lungs, because that’s the most logical location.

Molekevic: The brain is the destination, but we have to go through the heart to get there. It’s Grand Central Station. The good news is we can get pretty much anywhere from here. The bad is that the tissue us extremely sensitive and will reject anything foreign or artifical in — well, a heartbeat.

That must be shocking news for the thousands of people with artificial heart valves, not to mention the hundreds of thousands of people with pacemakers.

While in the heart, the shuttle is attacked by hundreds of tiny insectoid robots. The Thing heads outside to fight them off.

General Ross: What’s happening Dr. Storm?
Dr. Storm: She’s gone into cardiac arrest.
Ross: And where are Grimm and Molekevic?
Storm: From the look of it, they’re putting the attack in heart attack.

That is either a confused scientist or a very bad joke. Cardiac arrest and heart attack do not mean the same thing. A cardiac arrest indicates that the heart has stopped (i.e. “arrested”). It can be caused by a heart attack, but it can also be caused by other things such as an arrhythmia (bad heart rhythm), direct trauma, or blood loss. On the other hand, a heart attack occurs when one of the tiny coronary arteries (the arteries which supply blood to the heart muscle itself) is blocked. Some of the heart muscle dies, causing a heart attack (myocardial infarction in medical terminology). Large heart attacks can be immediately fatal, but smaller ones can occur undetected.

The shuttle heads out of the heart and towards the carotid arteries and the medulla oblongata. Somewhere along the way they cross into the cerebrospinal fluid (the liquid surrounding the brain) — and once again I’d like to know how; the blood-brain barrier is tough to pass. The carotid is also not a very good route to get to the hindbrain, but maybe the goal was just to get into the cerebrospinal fluid and then float down to the medulla. The Omega Synapse (cue music!) is located and fried with the laser. Unfortunately, the robot insects have followed them and the battle continues. During the fight, the shrinking machine is injured and Grimm and Molekevic have to quickly leave Sue’s body before they return to normal size within her.

Sue survives, as do Ben Grimm and Arthur Molekevic. For better or worse, Dr. Storm and General Ross also survive.

Take home message: Fantastic Voyage is a really good movie.

This episode of Fringe introduced a new antagonist as well as new protagonist/hostage, and also features some spectacularly bad medical science

The Plot: Agent Dunham had been kidnapped at the end of the previous episode. As this episode begins, she is strapped down to a gurney by her captors and ends up on the receiving end of a spinal tap. We manage to catch a glimpse of one of her abductors: Agent Loeb (from episode 7). Dunham manages to escape, and in the process steals some suspicious looking test tubes.

Dunham calls in reinforcements, but the FBI agents who show up subdue and tranquilize her. It turns out that there is an internal affairs investigation into the FBI “Fringe” office, and it is being headed up by an investigator who bears a grudge against Agent Dunham. Tranquilizing her was his way of letting her know who is boss.

Meanwhile, a world-famous immunologist is lecturing at Boston College when he suddenly starts choking and collapses. A giant slug-like beastie emerges from his mouth and escapes into the auditorium. Agent Dunham and her team are called in to investigate. She determines that the late immunologist was asked to head a secret CDC task force concerning epidemics. Another local doctor has also been asked to serve on the committee, and he is brought in to protective custody by Dunham. It’s all for naught though, as Agent Loeb kills him by dosing his water with giant slug eggs.

About the same time, Walter discovers that it is not actually a giant slug, but a gargantuan cold virus. The samples Dunham stole from her captors are some of the (for lack of a better term) slug eggs.

Dr. Bishop: It’s viral — nasopharyngitis — albeit a gargantuan specimen

Thanks to his poor shoe-related hygiene, Agent Dunham has now realized that Loeb is a turncoat. She heads to his house to see if she can find anything incriminating, and she does find some suspicious documents, but she also finds his wife. A catfight breaks out that ends with Olivia shooting and killing Loeb’s wife. Meanwhile Charlie asks Peter’s help in setting up a tap on Loeb’s phone. They finish just in time to hear Loeb tell his wife to kill Agent Dunham. Peter calls Dunham to warn her and that’s what sets off the catfight.

In the end, Agent Loeb is captured and when informed his wife has been killed, admits that he murdered the two scientists. When asked about abducting Dunham, he replies that he wasn’t trying to kidnap her, but instead to save her.

There wasn’t all that much science in this one, but what there was hemorrhoid-inducing bad.

1. No Virus I Ever Met
A gargantuan cold virus? Nonsense. It is physically impossible for viruses to grow that large. There are many reasons for this; for starters, here’s the square cube law.
Furthermore, they kept confusing a virus and a cell, which are two entirely different things. A virus is much smaller than a cell — it just consists of some nucleic acid (DNA or RNA) and a handful of proteins. Because it is not a cell, comparing it to giant cells means nothing.
Nasopharyngitis is not the name of a virus, it is the name of a condition: a runny nose and a sore throat, i.e. a cold. Cold viruses are typically rhinoviruses or adenoviruses.
How could it have grown so big so fast?
There are certain parasites that protect themselves in hard-walled cysts that breakdown when exposed to stomach acid, allowing the parasite to become active — so that part is not too far fetched.
Decongestants treat the symptoms of the cold (or more accurately the symptoms caused by the body’s reaction to the cold virus). They wouldn’t have any effect on the virus itself.

2. Cover Up the Slide’s Title Next Time
Simian Hemorrhagic Fever is a real disease, but it (like most hemorrhagic fevers) is a viral disease. The slide Walter was looking at was clearly labeled leptospira, a bacteria that causes (wait for it) leptospirosis. The “intricate web” he was talking about was just a bunch of the leptospira bacteria. Look at the picture on Wikipidia, it’s pretty much identical.

Marge Bannerman has a problem. Her father runs a carnival freakshow but an unscrupulous competitor has lured all his freaks away, and her father is now on the verge of going bankrupt.

She goes to her friend Bob Benton for help because she knows that a pill can solve any problem¹.

Luckily Bob has just the thing for her — the latest wonder drug: Camiana. He gives her a bottle of the pills and she returns to the carnival^2.

She asks the single remaining freak to take the pill, and he agrees. A little while later, in the middle of his act, the pill kicks in and he lights up like a glowing skeleton³

Bob Benton: That drug is a wonderful aid! It lights up the human form, and may well prove as great a discovery as the x-ray!

This sight brings the customers in droves and soon the sideshow is making money hand over fist⁴. Once again, medicine saves the day.

Notes:
1. Kidding! Kidding! Sometimes it takes liquid medicine instead of pills.
2. It sure sounds like he’s prescribing medicine without a license
3. This certainly doesn’t look healthy to me; if anything, it looks suspiciously radioactive. The unfortunate guy doesn’t look to happy about it either. I have a feeling he’ll end up like one of the poor radium girls.
4. Of course, the comic’s not quite over as it is a “Black Terror” story, and not a “Bob Benton, pharmacist” story. Like any Black Terror story, this involves a tremendous number of fist fights and the Terror getting hit over the head and knocked out at least once (seriously, the Black Terror is worse than Black Canary).

A mere 4 days until Christmas, and for today’s #4 cover, I dip back into the super-hero bag for Generation X #4. This was a great series, at least for the first year or two, with good writing, interesting characters, and good Bachalo art. It was a fun comic, something sorely missing in today’s mainstream X-titles.

Generation X #4 (Marvel Comics, February 1995)

Click on the cover for larger view

4 Days until Christmas!

This year’s Comic Book Cover Advent Calendar (so far).
One year ago, the cover was Batman Family #4.
Two years ago, the cover was Fantastic Four #4 (creepy variant cover).
Three years ago, the cover was Jingle Belle #4.
Four years ago, the cover was Street Fighter #4 (variant cover)
Don’t miss Yet Another Comic Blog’s annual advent calendar

I figured it was time to take a look at Batman: Knightfall, the storyline where Batman has his back broken by Bane, and then begins the process of recovery.

I hope it goes without saying that Batman’s recovery is nothing short of miraculous: in less than two years, he manages to go from struggling to breathe to a full return to crime fighting, none the worse for wear. As the late night infomercials say, “results not typical”.

For the purpose of this post, I’m going to focus on the period initially after the injury where he is under the care of first his faithful butler Alfred, and then neighborhood physician Dr. Shondra Kinsolver.

I. The Injury
To start off, let’s take a close look at what happened to the Dark Knight. There are two mechanisms of injury here. First, Batman’s spine is hyperextended; it’s bent backwards farther than any back is meant to go. Second, Bane is driving his knee into the back, pushing the spine forward.
[click here for an annotated image.]

II. The Doctor’s Assessment

Dr. Kinsolving: These x-rays clearly show a fulcrum-type stress fracture. Not at all the kind of trauma sustained in a car crash.

Dr Kinsolving is both right and wrong.

She’s right in that the way the injury was explained to her (a car accident) does not match the injury she observes (blow from behind). Alfred tries to explain it away, but she’s already suspicious.

However, she’s wrong in the way she herself describes the injury. While Bane’s knee was used as a fulcrum to break Batman’s back, what he suffers is not a fulcrum fracture per se. Those are a type of Chance fracture and occur with hyperflexion (the back bending forward too far), not hyperextension.

It’s not really a stress fracture either. Those can occur in the spine, usually with an increase in repetitive trauma (for instance, athletes who increase their workout), or with trauma. However, stress fractures of the spine don’t occur in the verterbral body, and do not occur with the kind of trauma Batman experienced.

Despite what she says, I don’t seem much of a fracture on the x-ray she’s holding up, unless it’s the diagonal line on the vertebra. If that’s what she’s referring to, it doesn’t match the type of injury she’s describing, or the one Batman suffered. [click here for an annotated image.]

(Based on the mechanism of injury, I’d predict that Batman suffered a fracture/dislocation injury. There was some spinal breakage occurring, but most of the injury is from one or more of the vertebrae being pushed forward into the spinal cord, injuring it).

III. Steroids
Steroids are a good treatment for spinal cord injuries. Bear in mind the term “steroid” generally refers to one of two related, but distinct, classes of medication.
1. There are the infamous anabolic steroids. These are the ones that cause an increase in muscle mass and have been abused in most major sports; Bane’s own drug Venom is a particularly fast acting and potent anabolic steroid.
2. Then there are the glucocorticoids (a type of corticosteroid). These are potent anti-inflammatory and immune suppressing drugs. They are used for asthma attacks, poison ivy, autoimmune diseases and other conditions where it is important to calm down inflammation or the immune system. This is the class of steroid that is used in treating spinal cord injuries; it reduces the swelling and improves the recovery.

Decadron was not developed for or “specifically made” for spinal cord injury. It has many medical uses and was around a long time before anyone thought to use it for spinal trauma.

Additionally, it is not a controlled substance and is easy to obtain with a prescription. We have a large supply in a drawer in our office. I suspect the writer is confusing it with an anabolic steroid — which is a controlled substance.

It all starts when Captain America receives a note from Keith, a member of his Teen Brigade. Keith plays on his high school baseball team and is concerned about the team’s star pitcher Mitch. Recently, Mitch has started performing poorly, wheezing, and acting very anxious. Keith also tells Cap that he saw a strange man on a street corner giving something to Mitch, but Mitch wouldn’t tell him what it was. Keith is worried about Mitch and asks Captain America to check it out, especially with the big state championship game coming up.

After getting the note, Captain America decides to head down to the championship game. Mitch is pitching, but he’s not doing well. The opponents are getting hit after hit. Shaken up, Mitch loses control and beans the next batter, knocking him out. This nearly starts a riot, but Captain America is there to sort things out. After it becomes evident that Mitch has been using illegal drugs, Captain America decides that he needs to talk to him. Scared, Mitch flees from the scene, and while running through town encounters the dealer who sold him the drugs in the first place. The dealer offers him more, but Mitch slugs him. Of course, he then runs into a bunch of guys from the other team and the obligatory fight-scene-that-needs-to-be-broken-up-by-the-starring-hero occurs. In the end, Mitch learns his lesson and swears never to do drugs again.

All in all, a decent PSA comics, not even counting the aliens. Didn’t I mention the aliens? See, the whole thing was actually a plot by aliens who want to overthrow the Earth. These aliens have been watching us for some time and are concerned that humans have too much spirit and determination and would put up too much of a resistance to invasion. The alien leader thinks drug addiction might be a good way to subdue the humans, and to test his theory he chooses four random people and tries to get them addicted to drugs. Mitch was the first of these four. And Mitch’s drug dealer — an alien in disguise. So you see that Mitch’s rejection of drugs not only saved his own life, but the lives of everyone else on Earth as well (though the other three experimental subjects are never mentioned — I guess they were saving them for the sequels).

Captain America Goes to War Against Drugs was published by Marvel Comics in 1990, with cooperation with the Federal Bureau of Investigation. It was written by Peter David, with interior pencils by Sal Velluto and cover pencils by Jazzy John himself.

More PSAs

Nightwing #148 “The Great Leap, part 2″
Peter J. Tomasi, writer
Rags Morales, penciler

After being shot with a bullet in the right shoulder, Nightwing makes it to the Batcave where Alfred performs arthroscopic surgery to remove the bullet fragments.

Arthroscopic Surgery (also called arthroscopy) is a type of joint surgery which uses a special fiberoptic scope that allows the surgeon to explore and repair the injured joint while minimizing the trauma from the surgery itself. The scope is attached to a camera and the surgeon follows the action on a video screen. Arthroscopy can be used on a variety of joints (shoulder, knee, spine, etc.) and for a variety of procedures — in this case, removal of a foreign body.

A small incision is made for the arthroscope and another small incision is made for any additional instruments (a blunt probe is commonly used; A pair of forceps to remove the bullet is used here). The surgeon watches the video screen as he manipulates the arthroscope and other instruments. The joint is explored, bullet fragments are found and then removed. The instruments are then withdrawn and dressings applied to the incisions. Healing time is quicker than traditional open shoulder surgery — athletes can usually return to action within a few weeks to a month. On the other hand, I think it’s fair to say that Nightwing running off an hour or two later to resume the good fight is not one of his better ideas. He must not be particularly fond of using that shoulder.

Depending on the location and extent of the surgery, general, epidural, or local anesthesia can be used. Alfred is grousing because Nightwing asked only to use lidocaine — a local anesthetic — for the surgery. Given the wound location, this is actually a reasonable choice. The lidocaine could be used as a local anesthetic or to provide a brachial plexus block (the brachial plexus is a collection of nerves in the shoulder that contains all the nerves of the arm). The latter would be the best option, but as it affects the entire arm and takes several hours to wear off, it would limit Nightwing’s ability to go gallivanting across the rooftops later that night.

Other thoughts:
Nightwing tells Alfred to avoid nicking a nerve, which is an unusual request as there are no nerves in the shoulder joint. He might be referring to the incision into the shoulder, but at the time he says it, Alfred’s already well into the operation.

The arthroscope doesn’t provide any advantage in removing the bullet from the wound in Nightwing’s side. It’s not a bullet lost in a wide-open joint, but instead one lodged in the abdominal muscles. A standard surgical exploration would be best.

I see that Alfred is not wearing eye protection or wearing a full surgical gown. Given that he considers Nightwing “family,” he might feel that these aren’t necessary. Anyway, I doubt OSHA is likely to spring an inspection on the Batcave.

I suspect Alfred reads the journal Arthoscopy. From the June 2007 issue of the journal, in the abstract of an article entitled Acute Arthroscopic Removal of a Bullet from the Shoulder:

“Bullets and lead particles in synovial fluid dissolve in time and cause periarticular fibrosis, chondrolysis, hypertrophic arthropathy, and sometimes chronic lead intoxication.”

Here’s what our favorite surgeon/butler tells Nightwing:

“…otherwise the lead particles in the synovial fluid could dissolve in time and cause periarticular fibrosis, chondolysis, even hypertrophic arthropathy.”

As usual, Rags Morales provides solid medical-related art. However, if I, if I really wanted to nick-pit, I would point out that arthoscopic images are always round (because the camera looks through the round scope — and speaking of cameras, there doesn’t seem to be one attached to the scope. It should fit over the eyepiece).

One last thought: Alfred’s priorities and sense of timing are horrible. Nightwing showed up to the Batcave bleeding from a bullet wound. Alfred’s first priority was to stop the bleeding. After accomplishing that, there was little need for him to perform joint surgery and remove the bullets at that time. The complications he describes are all chronic conditions and would take weeks, if not months, to occur. If he knew Nightwing was going to finish his mission as soon as possible (and you know he did), then Alfred should have postponed the surgery until later and spare Nightwing any surgical complications and need for recovery while fighting crime that night.

The top five Robert E. Howard characters, presented in order of preference.

1. Solomon Kane
A puritan who obsessively fights evil, armed with only a sword, musket, and his unwavering sense of righteousness. His stories tend toward a darker, grimmer view of the world. Kane has the best sense of style of any literary swordsman — I always played the Witch Hunter character in Warhammer Quest because he is clearly Solomon Kane. The best story is Red Shadows, where Kane travels the world tracking down the killer of a girl he never even knew. (Wikipedia link: Solomon Kane)

2. El Borak
Francis Xavier Gordon was a Texas gunfighter and adventurer who settled among the tribes of Afghanistan and had adventures among the deserts and mountains of Asia. Think Lawrence of Arabia combined with Captain Blood. The best story: Hawk of the Hills. (Wikipedia link: El Borak)

3. Kull
Not to be confused with Krull (and I like to forget the Kevin Sorbo movie ever happened). There were only a few Kull stories, but they were all good. The best: The Shadow Kingdom. (Wikipedia link: Kull)

4. Conan
The best known of Robert E. Howard’s characters. Truly, there have been some great Conan stories, but he also has his share of stories that are just okay, and that’s what marks him down in my eyes (and I’m only counting Howard’s stories; not the lesser Conan stories written by Lin Carter or Robert Jordan or others). My favorite: Red Nails. (Wikipedia link: Conan)

5. Bran Mak Morn
A darker series of tales. Bran Mak Morn is the last king of the Picts, a degenerate and dying race. The best story: Worms of the Earth. (Wikipedia link: Bran Mak Morn)

Solomon Kane	El Borak

Comics:
Most of these characters have appeared in comics at one time or another.
Solomon Kane appeared in an adaptation of Red Shadows in Marvel Premiere #33-34 in 1976, then had a six-issue mini-series from Marvel in the mid-eighties that featured adaptations of existing stories as well as new stories (and some nice Brett Blevins art). A new mini-series from Dark Horse has just started, and so far, seems good.
Conan has appeared in numerous comics published by Marvel and Dark Horse, the majority of which have been quite good.
Kull appeared in a handful of Marvel books in the ’70s and ’80s. I haven’t read them, so I can’t vouch for their quality. Dark Horse has a new Kull series coming out soon.
Bran Mak Morn appeared in several issues of the Savage Sword of Conan in the ’70s. Dark Horse published a two issue adaptation of Kings of the Night in the mid-’80s. It was not their best work.
To the best of my knowledge, El Borak has never appeared in the comics.

A strongly mediocre episode of Fringe. At least the science and medicine wasn’t too bad this time around.

And Peter’s whining is really starting to get on my nerves.

The Plot: An explosion at a construction site occurs in Manhattan. The public is told that it was a gas main explosion, but that’s only part of the story. A 2 foot long metal egg-shaped cylinder was found in the rubble and it had apparently tunneled up to the surface from underground at high speeds and hit a gas main, causing the explosion.

Dunham and her team are called in. The object is moved to a warehouse command center, but Walter has it moved to his lab at Harvard. This turns out to be a good thing, because a thug wielding a futuristic weapon attacks the warehouse looking for the egg. Back at his lab, Walter wonders if the egg might be related to Project Thor, a plan he once worked on that featured an underground torpedo. When he and Peter hear about the warehouse attack, Walter decides to hide the egg. He sends Peter off on an errand, then sedates Astrid. He grabs the egg and flees.

Walter is eventually found hours later and tells Agent Dunham that he hid the egg, but doesn’t remember well. Meanwhile, the thug is still trying to find the egg. He abducts one of Dunham’s contacts and uses a through-the-nose mind reading machine on him. Later, he abducts Peter Bishop, uses the same machine on him, and discovers the location of the egg’s hiding place — even though Peter isn’t aware that he knows it. Dunham tracks Peter and the thug to the graveyard where the egg was hidden and guns down the thug during a chase. The egg burrows into the ground and disappears. Peter confronts a strange bald man who seems to be linked to the Pattern and has been observing events for years. He ends up on the losing side of this fight as well.

Not much to comment on science- and medicine-wise (except for the obviously ridiculous mind reading and “learning by osmosis” ideas). The rest is just nit-picks:

1. The Arrival
Sadly not related to the Charlie Sheen B-movie sci-fi flick The Arrival.
Which incidentally stars Ron Silver — who I have been reliably informed is actually a deadly assassin working for NASA. I expect this fact to show up in Fringe sooner or later.

2. Project Thor
Was the egg part of Project Thor or not?

3. Iridium
Iridium is a logical choice for a torpedo that travels through the earth as it is one of the most heat resistant metals known.
Solid Iridium is a yellowish-platinum color though, not indigo.
Astrid should have seen what was coming. Iridium is the second densest element, how was a tiny syringe going to penetrate it?

4. Mind Reading, take two
Enough with the mind-reading already — although the thug’s model appears to be an upgrade as it conveniently converts thoughts into sounds (though only mono). And uses an oscilloscope.

5. Osmosis Jones
Learning through osmosis and proximity? Nonesense. If that actually worked I would have aced every test in college and med school, and though it pains me to reveal this, I did not.
Reminds me a little too much of the discredited Hundredth Monkey Phenomenon.

6. The Observer
A bald guy who observes. Where have I seen that before?

Just how much of a badass is Batman?
 
He donates blood to vampires…voluntarily.

scene from The Brave and the Bold #195

The context: Batman is hunting gangster Johnny the Gun, and Andrew Bennett (aka I…Vampire) is hunting his ex-lover turned evil vampire Mary. Their paths cross when they discover that Mary has turned Johnny the Gun into a vampire gangster. A fight ensues, and Bennett takes the bullets meant for Batman (that, of course, just happened to be silver). Batman repays Bennett’s actions by donating enough blood to keep the vampire alive. I’d make my usual comment about blood types now, but do vampires even have blood types?

Other Comic Book Transfusions

Detective Comics #848 “Heart of Hush”
Paul Dini, writer
Dustin Nguyen, penciller

There are lots of spoilers here, so don’t read past the warning sign unless you’ve already read Detective Comics #848, don’t plan on reading it, or promise not to whine about the plot being spoiled.

The key portion of the plot, in Haiku:

Catwoman captured
deprived of her heart by Hush
left at hospital

First of all, let me state what is hopefully obvious. This is no way resembles realistic medicine. It is what can be best described as “classic comic book medicine” — the same kind of medical science that attaches a man’s head to a gorilla’s body or turns someone into a man/bat hybrid. That’s not to say it’s bad, per se, just horribly inaccurate.

Without knowing where Dini is going with this, it’s hard to speculate precisely what’s happened to Catwoman (Selina Kyle), so I’ll make some educated guesses (and probably some less educated guesses as well).

There’s so much to address in this issue, I’ll just hit the highlights. If there’s anything I gloss over or miss, just mention it in the comments and I’ll address it.

Let’s start by looking at the final scene, with Selina attached to every (steampunk looking) machine in the hospital, including — presumably — the machine that goes ping, after her heart has been removed by the villain Hush.

Selina’s heart is missing, so she’s hooked up to either some sort of artificial heart or heart-lung bypass machine. Given the art, it’s hard to tell which. Selina has tubes bringing blood to and from the heart, and we can see blood in the various pumps, so that suggests a heart-lung machine. But on the other hand, why all the wires — especially that huge 220V cable — leading into the chest cavity unless there’s something in there requiring electrical power (and even so, that’s a hell of a lot of wires). I suspect the artist thinks that a heart-lung machine actually involves an artificial heart placed in the chest and doesn’t realize that all the pumping is performed externally.

How did Selina get hooked up to this monstrosity of a machine? According to Oracle, she was dropped off anonymously at Gotham General in an abandoned ambulance. Was she hooked up to any machines then, or just propped up — her heart missing? All that equipment couldn’t possibly fit in the back of an ambulance, so much — if not all of it — had to have been attached once she arrived at the hospital. Is this really the best equipment the hospital has? And why are a keg, a muffler, and R2-D2 (the same one from Werewolf by Night, apparently) as part of the machine?

Finally, a few thoughts on the de-heartification surgery scene earlier in the issue:

• Removing a heart — presuming one wants to put it, or another one, back — is an operation that takes more than one surgeon, even if they are the Best Neurosurgeon in the World* (and this is cardiothoracic surgery, not brain surgery).
• It’s nice of Hush to wear surgical gloves and a mask over his bandages (though he’s still missing eye protection and has too much exposed skin for him to be considered in surgical garb).
• Speaking of skin exposure, if Selina is “prepped and ready” for heart surgery, why is her gown still on?

*The phrase “The Best Neurosurgeon in the World” is ™ and © Polite Dissent.

After gaining infamy for its lurid horror comics, EC Comics tried to rehabilitate its image by releasing its “New Direction” of wholesome comics. These included titles such as Valor, Aces High, and Impact as well as the medical comics M.D. and Psychoanalysis. As the name suggests, in Psychoanalysis the reader follows an unnamed pipe-smoking psychiatrist as he attempts to analyze and cure his patients.

Previous “analysis” of Psychoanalysis issues one, two, and three

For his first appointment, the psychiatrist sees Freddy Carter. Freddy is a fifteen year old who was initially brought for counseling after being caught stealing. The doctor deduced that the theft, along with Freddy’s asthma and poor grades, are really just desperate cries for attention. His parents are constantly sparring with each other — figuratively at least — with Freddy as the battleground.

The subject of this particular session is Freddy’s recent report card. Freddy is failing math and science — the classes important to his father — but doing well in English and history — classes important to his mother. In retaliation, Freddy’s father has grounded him and cut off his allowance. In addition, he has stopped giving any money to his wife other than for groceries, and he fired the maid. After talking with Freddy for several minutes, the doctor goes out to talk to Freddy’s parents who are upset that Freddy isn’t cured yet. The doctor points out that as long as the two of them are fighting, Freddy will never be cured because they each desire a different outcome. The doctor convinces the two of them that they each need psychiatric counseling for the good of their marriage and for Freddy’s sake. They both agree, and the doctor trades a single paying patient for two.

The last portion of the comic shows two sessions with Mark Stone, an unhappy screen writer. Mark has many difficulties, including problems with women, resentment towards his own success, and longstanding issues with his parents. This time, he is angry the psychiatrist because feels that he has become overly dependent on him. The doctor is able to get Mark to calm down, and then has him describe a recent dream. After hearing the dream, the doctor tells Mark that he is not mad at him, the psychiatrist, per se, but instead angry at authority figures in general — which goes back to his anger towards his father. The doctor is also able to deduce that Mark has a deep-seated fear of being abandoned, which brings out his feelings towards his mother. This has come to the surface because of the doctor’s upcoming vacation.

At a later session, Mark has once again started to experience the severe panic attacks and anxiety symptoms that brought him to the doctor in the first place. They started just a few days after Mark and the psychiatrist agreed that Mark had made remarkable progress and could cut back on his sessions. It doesn’t take a genius — or a board certified psychiatrist — to realize that this is nothing more than a subconscious reaction on Mark’s part. He is uncomfortable with the idea of cutting back on the counseling, so he recreates the symptoms that necessitated the visits in the first place. The psychiatrist is able to get Mark to realize the root of the problem, and once again Mark agrees that he doesn’t need many more sessions. This is probably a good thing as this was the final issue of Psychoanalysis.

Previous Flashback Weeks

Script by Michael Golden, pencils by Ramon Bernado

For today’s example of a psychic nosebleed, we return to chronic bleeder Nate Grey, i.e. “X-Man.” In this scene from X-Man Annual ‘97, Nate is using his powers to fight explosive decompression and close an enormous hole that has been ripped in the side of a Shi’ar destroyer (or maybe it’s a cruiser, I could never tell those apart).

Not to give too much away, but he succeeds.

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed x-man nate grey shiar

By day, Bob Benton is a seemingly normal — and incredibly brilliant — pharmacist who runs his own small drug store. However, whenever evil or danger appears, he becomes the costumed crime-fighter known as the Black Terror. Thanks to “formic ethers” he invented, he has gained heightened strength, speed, agility, and endurance. But even more than that, he has the power of pharmacy.

This is impressive detective work on the Terror’s part. He is able to recognize the exact drug in the pill, despite the fact that it was a specially compounded pill. In other words, this was no mass-produced pill, but instead one that was created from the constituent chemicals by a local pharmacist — no easy to read manufacturer’s markings! That’s why it’s so impressive that the Terror was able to identify the medication just by looking at it and without having to run any tests at all.

Dilantin sodium (more commonly known as just “Dilantin“, or by its generic name “phenytoin“) is a potent anti-seizure drug. It was first discovered in the early 1900s, but it wasn’t until 1938 that its ability to treat seizures was recognized. It was approved by the FDA for epilepsy in 1953, and quickly became one of the main seizure medications because it lacked the severe sedative side effects of previous medications. It is still a common medication for epilepsy today. (This story appeared in 1947, several years before Dilantin was FDA approved, so the Terror is probably correct in referring to it as a “rare drug” — at that point it was, for a few more years anyway).

There has been some evidence over the years to suggest that Dilantin has a role as a psychiatric medication as well; it seems to show both anti-anxiety and mood stabilization properties. It is these anti-anxiety properties that the Terror is referring to, implying that one of the crooks was using it to treat his anxious tic. (For the record, Dilantin has never been FDA approved for these psychiatric conditions.)

Bob Benton tracks down the local pharmacy that made the pills, and the pharmacist helpfully tells him exactly who the pills were for. So much for patient confidentiality. (This may have been before HIPAA, but I suspect sharing such information so freely was at the very least a breach of pharmacist ethics, if not state law). Thanks to the helpful pharmacist, the Black Terror shows up the crooks’ front door step, apprehends them, return the stolen jewelry, and gives the antique chair to the old man. Just another day in the life of a super-pharmacist.

The good old days: when mad scientists could concoct evil drugs and schemes in their own basement labs. Nowadays, it seems to take at least a university lab — more commonly an entire industrial chemical research lab — just to create one marketable evil drug. Just ask Norman Osborne (especially the “Ultimate” version) — how many scientists did he have working for him?

In this scene from Detective Comics #61 (March 1942), an unnamed mad scientist has discovered a drug that makes people lazy. How lazy? So lazy that victims will be too tired to eat and will starve themselves to death. Like any good mad scientist, he has a scheme to make money off his drug (money which will be used for more mad science — that’s how the cycle works). He slips some of his drug to an important corporate leader, and then extorts money from his corporation or he won’t provide the antidote (and isn’t it nice how mad scientists always take the time to concoct an antidote?)

Unfortunately, the scientist chose the wrong company this time: a company where Bruce Wayne was sitting on the board of directors. As the scientist left, Wayne switched into his Batman persona and followed him back to his lab. In the scuffle that followed, the scientist managed to get the upper hand and forced Batman to drink his lazy drug. It worked just as promised:

Batman: Suddenly feel tired — lazy — need a vacation from fighting crooks — out to take a month fishing. Sooo tired — think I’ll take a nap…

Batman didn’t succumb as quickly as the mad scientist expected though, and he was able to secretly signal Robin, who managed to knock out the scientist and find the antidote for Batman (and presumably the CEO, though that was never mentioned). The fate of remaining supplies of the lazy drug was never mentioned either. I suspect that it’s still around. The next time you feel like staying in bed all morning and lazing the day away it just might be because somebody slipped you the lazy drug…

I’ve discussed commotio cordis a couple of times, most recently in relation to Batman #672-674.

Commotio cordis is a rare and frequently fatal condition. It occurs when an individual receives a direct blow (blunt trauma) to the chest at precisely the right time in the cardiac cycle to stop the heart and cause a cardiac arrest. Children are more susceptible to the condition than adults.

Sports injuries are a common cause of commotio cordis, particularly thrown baseballs and softballs. Other causes include physical blows to the chest during a fight, steering wheel impact in motor vehicle accidents, and even the blunt force of bullets stopped by body armor.

The best, and really only, treatment for commotio cordis is immediate cardiopulmonay resuscitation, usually requiring defibrillation and cardiac medications.

Wikipedia has a good write up on commotio cordis

Commotio cordis has been in the news recently because of a lawsuit filed by a New Jersey family against several groups: a maker of aluminum baseball bats, the Sports Authority*, and Little League Baseball**. It’s an unfortunate story on many levels: Twelve year-old Steven was pitching in a baseball game when a line drive hit by the batter caught him square in the chest, causing his heart to stop beating. He was eventually revived, but remained in a coma for several weeks, and now has severe brain damage.

It’s a sad story and an unfortunate case, but personally I think it’s a stretch to treat it as cause for a lawsuit. I know that we Americans always like to blame someone when something goes wrong, but there are times that it’s not appropriate. This is one of those times.
There is no hard evidence that aluminum bats are any more dangerous than wooden ones, particularly in cases of commutio cordis (remember, it’s an issue of timing, not an issue of force).
There is an inherent risk of injury in playing any sport. Proper safety precautions will minimize this, but never eliminate it entirely. I am well aware of this whenever I go for a bike ride on the back country roads near me. Who knows what drunk-driving redneck may be out there weaving across the center line?***
And suing Little League because they endorsed the bat? Give me a break.

*The store where the bat was purchased
**Not because it was a Little League game — it was not — but because they “endorsed” the bat as safe.
***It would be like me, after getting hit by a reckless driver, suing Ford because the person was driving a Mustang and those can go faster than other cars. It may be true (arguably), but it really has nothing to do with the accident and injury.

A double psychic nosebleed in Ultimate X-Men #93. Of course, most of the issue describes a fight between the two strongest mutant minds on the planet, so you knew that noses were going to bleed somewhere in this issue.

The image on the left is our first combatant, Apocalypse, while the image on the right is our second fighter, Charles Xavier.

Ultimate X-Men #92 is by Rober Kirkman and Salvador Larroca.

All previous Psychic Nosebleed Zen posts

I’ve decided it was finally time to get around to blogging about Armageddon 2001, and what ended up being the coda on Karl and Barbara Kesel’s run on Hawk and Dove. For those of you who may not remember, Armageddon 2001 was the “big event” comic series of 1991. It started off promising, but whimpered to an end — and took Hawk and Dove down with it.

Armageddon 2001 #1
In the future — the year 2030 to be precise — Matthew Rider is one of the world’s top physicists. He is an unhappy man, though. The future of 2030 is a dystopian fascist state, ruled over by the all powerful despot Monarch. Not much is known of Monarch’s past because he’s done his best to wipe out all historical records. All that Ryder knows is that Monarch was once a super-hero, but something happened in the year 1991 that caused him to become Monarch. By the year 2001, Monarch had destroyed all his fellow heroes and taken over as the unquestioned ruler of the world. It is clear that Ryder longs for the world before Monarch, when all the other heroes were still alive, and free thought and expression were allowed. As a young child, he was rescued by one of those heroes on that fateful day in 1991, but he cannot recall who, and the thought has haunted him for the past forty years.

Other scientists working for Monarch have discovered the secret of time travel, but their human test subjects have not survived the experience. Ryder volunteers for the program, but he is turned down because of his anti-state tendencies. Undaunted, Ryder is able to meet and convince Monarch that he has the will to survive that the other test subjects lacked, which Ryder argues will allow him to survive the time travel. Monarch is intrigued, but concerned about sending such an obvious malcontent back in time. However, he believes that Ryder’s love for his family will keep on the straight and narrow, so he agrees for Ryder to become a test subject. What Ryder has kept hidden is that the love of his family is overshadowed by the possibility of destroying Monarch once and for all, and that is the real reason he wants to travel into the past.

Ryder enters the machine and is sent back through the time stream to the year 1991 (coincidentally the same year these comics were published). Along the way, Matthew Ryder becomes the super-hero Waverider, who has the ability to see the events of someone’s future just by touching them. He resolves to use his power to find out which hero will become Monarch so that he can put an end to him before it happens.

The Armageddon 2001 Annuals
The DC Comics annuals published in the summer of 1991 all started the same way: Waverider shows up and touches the hero, revealing their future ten or more years down the line, searching to see if they will become Monarch (and none of them do). Most of these comics were surprisingly good, far better than most other themed annuals (Atlantis Attacks **cough cough** Days of Future Present). I covered the Hawk and Dove Armageddon 2001 Annual in more depth previously.

Armageddon 2001 #2
The second and final issue of Armageddon 2001 starts with Waverider touching Captain Atom and revealing his future. It is a dim and dark future that ends unhappily for pretty much the entire world. Captain Atom does not become Monarch, but he is just as much a threat to his own future. The shock of seeing what might happen causes Atom to briefly lose control of his quantum field. It’s just a momentary lapse, but it’s enough for Monarch to slip through into the present (well, the present of 1991). It seems he had followed Ryder into the past, but was prevented from entering by Atom’s quantum field.

Once Monarch has appeared, he wastes little time in attacking the Justice League. In the middle of the battle, he teleports away, but later informs the heroes that they must all meet him in Metropolis at 3PM the following day, or he will destroy the world.

In the meantime, Monarch puts his plan into motion. He shows up at the remote campsite where Dawn Granger (Dove) and her boyfriend Brian Arsala are having a romantic weekend. Without batting an eye, Monarch slaughters Brian and them immobilizes and kidnaps Dawn once she turns into Dove. Next, Monarch confronts Hank Hall (Hawk). He goads Hank into becoming Hawk, then immobilizes and kidnaps him as well. Monarch then snatches a variety of scientific equipment from around the world to build a specialized Neutron Bomb designed to kill every super-hero.

Before putting his plan into action, Monarch announces to Hawk and Dove that he still has two things to take care of. He grabs Dove and kills her, right before Hawk’s eyes. The sight of his partner’s murder and the loss of her “balance” is enough to drive Hawk mad. He attacks and kills Monarch only to discover that Monarch is actually the future Hank Hall. This knowledge sends him even farther over the edge, and he decides to become Monarch so that he can create his own balance in the world. He dons Monarch’s armor, takes his plans and weapons, and teleports off to fight all the heroes in Metropolis.

It’s an epic battle, but Monarch seems to have the edge. Then Captain Atom unleashes his full powers and they interact with Monarch’s, sending them both tumbling into the distant reaches of time stream. Meanwhile, Matthew Ryder discovers that the hero who saved his life on this day was none other than himself, as Waverider (and who didn’t see this coming?).

The Controversy
Did the ending of the series seem nonsensical, out of character, and cobbled together at the last minute? Well, it was.

In the original story, Captain Atom was to become Monarch. Clues were planted throughout the series and annuals pointing to him. But then somebody prematurely gave it away, and DC decided to rewrite the ending. That’s why it makes little sense — it was never supposed to be Hawk in the first place (for instance, you’ll notice Monarch has bright blue eyes in issue #1 — just like Captain Atom — but in issue #2, they’re suddenly brown like Hank Hall’s).
Wikipedia has a concise explanation of the controversy, and here’s a page I scanned in from Wizard #179 that interviews some of the key players.

The End?
So is this the end of Hawk and Dove? Yes and no. The Hawk and Dove redesigned by Karl and Barbara Kesel — based on the works of Ditko and Skeates — are gone. Hank Hall and Dawn Granger still make a few more appearances in one way or another, and I’ll cover that soon in an epilogue post. In the past few years, Dawn has taken up the mantle of Dove again, but with a heretofore unmentioned sister as Hawk (and there was the Mike Baron penned Hawk and Dove series in 1997 that bore no relation to the original at all, but the less said about that, the better). Then there is Infinite Crisis and its aftermath. Continuity seems to have been re-written (or corrected) so that Captain Atom is once again Monarch. But then, what happened to Hank Hall? Was he ever Monarch in this new continuity, or was it Captain Atom all along?

All Previous Hawk and Dove Reviews

Tags: comics hawk dove armageddon 2001 monarch waverider captain atom

(I meant to post this a while back, but it somehow got lost in the ether. It’s a follow-up to January’s posts on Tony Stark’s heart.)

So what’s the status of Tony’s heart now? Good question.
In Iron Man #30 (1998 series), Tony suffers (yet another) heart attack while fighting a sentient version of his armor. Instead of kicking him while he was down, the armor rips out its own heart and implants it into Tony’s chest (that’s what the second panel shows, though the action is far from clear).

The fact that Tony now has a purely mechanical heart was confirmed in the following issue:

This was the status quo as Iron Man, Volume 3 continued for 58 more issues. As Iron Man, Volume 4 — the one initially written by Warren Ellis — begins, the story changes. In this version, the shrapnel never actually penetrated or injured the heart, but would have if the magnetic fields of the Iron Man armor hadn’t kept it trapped 2 cm from the heart. Tony then goes on to say that medical science was finally able to remove the shrapnel. So in current continuity, until his recent takeover by Ultron, Tony never had an injured heart.

One last scene, which may or may not be relevant, occurs in Iron Man #5. After being injected with Extremis to save his life after a severe beating, fellow scientist Maya mentions his damaged internal organs. “Grew new ones,” is Stark’s reply.

Tags: comics medicine iron man tony stark heart heart attack

A DC comics super-hero Christmas cover! For the second day in a row! And just 4 days until Christmas! Anyway, here is Batman Family #4 which, in addition to stars Robin and Batgirl, features such luminaries as Fatman and the Phantom General. At least it’s got the Elongated Man in it, too.

Batman Family #4 (DC, 1976)
4 Days until Christmas!
click on image for larger view

The entire 2007 Comic Book Cover Advent Calendar (so far) in traditional calendar format.
One year ago, the cover was Fantastic Four #4 (creepy variant cover).
Two years ago, the cover was Jingle Belle #4.
Three years ago, the cover was Street Fighter #4 (also a variant cover)
Previous Comic Book Cover Advent Calendars: 2006 2005 2004
David Carter always has another good comic book advent calendar over at Yet Another Comics Blog

Tags: comics advent calendar christmas batman robin batgirl elongated man

Episode Title: In Which Dell Finds his Fight

A mediocre episode of Private Practice. The writers were clearly trying to tug the heartstrings with Dell’s grandfather but weren’t able to pull it off. Frankly, they didn’t even reach maudlin.

Dr Addison Montgomery and Dr. Naomi Bennett
Cathleen and Geoffrey, the couple who were having difficulties with vaginismus is a previous episode, are back to talk with Addison. They are concerned about fertility, and even though they’ve only been trying to conceive for 2 months, Addison agrees to go ahead and run some fertility tests. Cathleen’s tests are fine, and in fact show her to be ovulating. Geoffery’s sperm count, on the other hand, is zero. Addison and Naomi suggest adoption or using a sperm donor (though it might have been a good idea to work up why Geoffrey was sterile; it might have been something correctable). Geoffrey declines adoption because he knows that Cathleen wants to experience pregnancy. They look though the “Catalog” but can’t decide on a sperm donor. Geoffrey has the bright idea to use his brother Mark as a donor since that way the baby will have genetics close to his. Just as Cathleen is ready to go through the procedure, she and Geoffrey simultaneously tell Naomi to stop — as they both realize that they don’t want to use Mark’s sperm after all (because he’s a jerk, and they seem to believe that jerkiness in an inheritable trait).

Addison suggests a surgical procedure to look though Geoffrey’s testes to find some viable sperm and then use that to fertilize one of Cathleen’s eggs. As luck and prime time television would have it, Addison is able to find a single sperm and when they implant it into one of Cathleen’s harvested eggs, they fuse and the egg miraculously and instantly divides. The egg is implanted back into Cathleen and she leaves the office already feeling pregnant.
Since when is Addison a Urologist? She shouldn’t be poking around down there with sharp instruments without the right training.
The fertility treatments scenes were wrong on so many levels, it makes my head hurt just to think about it. Suffice it to say, real world fertility treatments bear little — if any — resemblance to what the episode showed. It is never a waltz in, waltz out sort of treatment.
Success rates with a single implanted egg aren’t particularly high, and in fact the odds are against Cathleen having a successful pregnancy. But then again, in an earlier episode, Naomi guaranteed she could get a couple pregnant and no real world fertility specialist would ever say that.

Dr. Sam Bennett
Dell comes to Sam because he is concerned about his grandfather Wendell. Dell has noticed that his grandfather often has bruises he is reluctant to explain and suspects that he might be a victim of elder abuse in his nursing home. Sam interviews and exams Wendell and his friend Nate. He does find a few scattered bruises but his patients assure him that they are not being abused. Sam is inclined to believe them, but Dell is convinced something is wrong. Naomi tells Sam to trust Dell, so Sam checks out the medical records of Nate and Wendell and finds a suspicious number of minor injuries over the past several months.

Sam and Dell go to the nursing home (after hours, of course) to check things out, but discover that none of the residents are in their rooms. They manage to track them to the back of a storage room where the residents are holding a boxing match featuring Wendell and Nate. Dell and Sam intervene, but it’s too late. Wendell hits Sam with a strong blow and he goes down — and stays down. Sam checks him out and realizes something is wrong with Nate’s heart and calls for an ambulance.

It turns out that Nate has suffered a heart attack. He does not fare well at the hospital and eventually dies. Sam reports to Wendell and Dell that Nate had a long history of heart problems and was “living on borrowed time”; he tells Wendell that he shouldn’t blame himself for Nate’’s death (whereas I think Wendell should bear much of the blame — it was his punch that finished Nate off after all). Wendell gives an (allegedly) impassioned speech about growing older that boils down to “carpe diem.”

Dr. Cooper Freedman and Dr. Peter Finch
In order to proved to Charlotte that he can be “bad,” Cooper — with help from Pete — runs a parenting workshop for new fathers. Not only is Cooper’s seminar in direct competition with Charlotte’s, but he steals her list of participants. They are not the best teachers in the world, but that works out all right, because they don’t have the best students either.
Naomi, Miss “I-can-guarantee-you-a-baby”, lectures Cooper about the cost of insuring a parenting class. A parenting class? I guarantee they are much more likely to get sued for unrealistic promises and infertility than anything taught in a parenting class.
I can’t be the only that finds it hard to believe that Charlotte would just shrug off a loss of $27,000 and a blow to her esteem in the hospital just for sex with Cooper.

Tags: television medicine private practice sterility heart attack parenting

A second visit to Dakota City and the Blood Syndicate reveals that the shapeshifter Masquerade is having problems with his/her power, and has a nosebleed when it goes out of control. This is shortly before she steals the rest of the team’s ill-gotten gains (though to be fair, they acquired it by robbing a crack house) and goes off on her own. The art in the panel is a little strange, and Maquerade ends up looking more like Legion (particularly as drawn by Sienkiewicz when he was penciling and inking The New Mutants) than like herself/himself (or one of the characters from Street Fighter). This panel is from Blood Syndicate #19, writen by Ivan Velez Jr with pencils by Chriscross. All previous Nosebleed Zen posts Tags: comics medicine nosebleed blood syndicate masquerade milestone

This episode brings an end to the applicant competition, with satisfying results. The medicine tried to be clever, but succeeded mostly in being nebulous and vague (and fairly confusing).

Jimmy Quidd is a 38 year-old punk rock singer. He is hard-drinking, like drugs and fights, and has a generally poor attitude and outlook on life. He also has a severe bloody cough that causes him to pass out in the alley behind a punk rock club. He is brought to the ER for evaluation where House admits him to his service because he feels Jimmy will make a challenging case for his applicants.

Jimmy has a long list of symptoms including fever, arthralgia (joint pain), hyperinflated lungs, fatigue, anemia, low blood oxygen levels, melena (blood in his stool) and hematuria (blood in his urine). He also shows signs of hard living including a history of multiple traumas, cutting, and a drug screen that’s positive for alcohol, cocaine, opiates, and amphetamines. House suggests drug use, trauma, and “being a loser” as possible explanations for his symptoms. The team suggests endocarditis, hemorrhagic lesions of the lungs and gut, bronchiolitis obliterans (inflammatory obstruction of the bronchioles in the lungs), and bacterial meningitis.

Amber starts out by testing her suggestion of bronchiolitis obliterans. Her plan is to perform a bronchoscopy (look down the lungs with a flexible fiberoptic camera), but Jimmy sneaks a cigarette while on a bathroom break — unfortunately, he’s on oxygen, which leads to a nice little explosion (though fires are much more common since oxygen is more of an accelerant than explosive), giving him smoke inhalation making a bronchoscopy useless. Now Amber wants to perform an open lung biopsy. While prepping him for the biopsy, Foreman realizes that he is wearing all his Nicotine patches at once and overdosing on nicotine. Amber and Kutner notice blood clotting in his fingers, meaning that Jimmy has DIC (disseminated intravascular coagulation), but the cause of the DIC is unclear. Amber suggests drug impurities, but Dr. 13 suggests malaria. This intrigues House, and she now takes over the case.

Meanwhile, Jimmy has disappeared. They manage to track him down in Pediatrics, entertaining the children. He passes out and is returned to his room. The malaria tests come back negative, but other tests show that “bad blood fragments” are causing the DIC. Kutner suggests blood exposure during sex as a cause for the fragments, and 13 mentions that the malaria medication may be causing the destruction of the blood cells (but he had DIC before he was started on the antimalarials). House points out what really should be obvious: that Jimmy has been shooting up drugs with dirty needles, and this has been getting other people’s blood into his system, which explains the blood fragments and the DIC.

The new differential includes inhalant abuse, bleeding problems, and infection. Kutner suggests chronic pulmonary embolism and takes over the case. House performs an echocardiogram on Jimmy. He finds some masses near the heart, but the study is hard to read because Jimmy was moving around too much. There is no evidence of emboli, so Taub suggests Jimmy may have an abnormal blood vessel wrapping around his trachea. He wants to check an MRA, but that will be affected by patient movement as well. Instead, the team elects to do exploratory surgery of the heart (do I really have to mention what a bad idea and how ridiculously unrealistic this is?). The surgery reveals no abnormal vessels. The masses House saw on the echo were enlarged lymph nodes. About this time, the patient starts to crash with plummeting blood pressure so he is given two units of blood and started on Dopamine (a drug used to raise the blood pressure in critically ill patients).

House threatens to fire Kutner and 13, and under pressure, they suggest ARDS (Adult Rrespiratory Distress Syndrome), anaphylactic shock, or an immune overreaction from impurities in the drugs he’s been using. House starts Jimmy on Dimercaprol to treat presumptive heavy metal poisoning from contaminated drugs, but this is not successful. House then threatens Amber and Taub with their jobs, and then the whole team, but they can’t come up with any coherent ideas. House takes their four “wrong” ideas, and combines them into a single diagnosis: measles. He thinks Jimmy has measles that his drug use made him susceptible to. His immune system is overreacting in response to the measles and causing his symptoms. House wants to perform a brain biopsy. Cuddy refuses, pointing out that Jimmy would be having neurological symptoms if House were correct. Amber mentions that he has been showing some abnormal swallowing, and it could be a partial complex seizure. House then tries — and succeeds — to induce a seizure in Jimmy (a generalized tonic-clonic seizure, though, different from a partial complex seizure). This is enough proof to allow him to get his brain biopsy which shows measles, so Jimmy is started on corticosteroids.

In the end, House fired Amber for being unable to lose. He then fires 13 and keeps on Kutner and Taub. It turns out his is all a ploy — Cuddy confronts him and tells him that he can’’t fire both women and insists that he rehire 13. House acquiesces, and as Cuddy leaves the room she realizes that had been House’s plan all along.

---

The medicine was almost too vague this week, throwing around poorly defined phrases such as “impurities”, “bad blood”, and “immune over-reaction”.

I did have some concerns:

How did Jimmy get all those Nicotine patches? A nurse will only give one a day — and make sure the old one is removed.

The heart surgery made my brain hurt, the logic behind it was that bad. You can’t sedate the patient for an ultrasound or MRA, but you can place him under general anesthesia and cut his chest open?

Once again, the show is being vague about symptoms — was it a bloody cough, or bloody vomit? It’s referred to as both during the episode, though the differential focused on the lungs not the gastrointestinal tract.

Exactly what test is performed to show “bad blood fragments”? House already pointed out that Jimmy had schistocytes (fragmented red blood cells) as proof that he had DIC, now the writers are invoking them as the cause of the DIC as well as the result?

Why was House performing an echocardiogram? Pulmonary emboli don’t show up on ultrasound (you need a ventilation/perfusion scan or a spiral CT), and furthermore, pulmonary emboli don’t generally come from the heart — they come from the deep veins of the leg.

If the measles infection/immune overreaction was in the brain, something should have shown up on the lumbar puncture (LP) which was performed earlier in the show.

If Jimmy had been having a partial complex seizure then he would have lost consciousness (that’s what the word “complex” means in the name), not just had strange swallowing. Partial complex seizures are very different from the tonic-clonic seizure House induced later.

---

The medical mystery was strictly average this week. Nothing very dramatic or eye catching (and whatever happened to all the great “inside the body” animations?), just an average C. I’m still trying to make sense of the final solution (his immune system was so weak it allowed a measles infection, but still strong enough to cause an autoimmune reaction?) — I think the measles part was clever, but the autoimmune aspect not so much. I’ll split the difference and give it a B-. The medicine was just too vague. There was a lot of hand waving and terms that didn’t really mean anything. It earns a C+. The soap opera was the best part, but still not as good as a few of the earlier episodes, and earns a B+.

The previous House review
A list of all prior House reviews

Challenge scores can be found at the post immediately beneath this one (or click here)

Tags: television medicine house punk rock bronchiolitis obliterans malaria pulmonary embolism measles

Title: In Which Cooper Finds a Port in His Storm

Not as strong as the last couple of episodes, but still an enjoyable hour of television. There was a lot of personal fallout from last weeks failed (and succesful) connections. Addison found a new interest, as did Cooper (and a devilish one at that), while Sam and Naomi are trying to figure out if last week’s rendezvous was a mistake or a starting point.
The medicine this week only fair. Epidemics of tropical diseases are always interesting, but the show managed to screw it up here, though it was still mostly interesting. The rest of the storyline was heavy on drama and light on actual medical care.

Dr. Violet Turner and Dr. Addison Montgomery
One of Violet’s patients is a man named Carl. He runs into Addison at the coffee stand downstairs and they strike up a conversation. A few hours later, he calls up Addison and asks for a date. They meet at a cafe down the block and are having a good time before Addison is paged away.
Carl, however, has a problem — an obsession, really. When he is in stressful situations, he likes to borrow other people’s belongings and…firmly place them where the sun don’t shine. After his date with Addison, he steals one of her shoes and puts it to a use for which it was never intended. As one might imagine, this is not a socially desirable skill set. Sadly and belatedly realizing this, Carl realizes that he should return to therapy and asks Violet to break it off with Addison for him.
Ethics, or lack thereof, is the too-often-repeated theme of this show. Despite lecturing Pete about ethics, Violet tells confidential information to Pete and Cooper, and then tells the whole story to Addison. Nice job, Violet. That whole doctor/patient confidentiality? Just forget about it. Must not be important at all, particularly for a psychiatrist.

Dr. Addison Montgomery and Dr. Peter Finch
Addison and Pete are the doctors on call for the Safe Surrender Program. This is a program where a young mother who feels she is unable to care for her newborn can call the team and they will pick up the baby — no questions asked — and keep it safe and healthy until foster care can be arranged. The mother and baby are given matching hospital bracelets in case she changes her mind later and decides that she wants to keep the baby.
They are called by a young woman named Darcy who has delivered a baby girl at home without her mother even realizing she was pregnant. Addison becomes attached to the baby and is clearly thinking about trying to adopt it herself when Darcy and her mother come to reclaim her.
Later, Pete and Addison are also called to a park where they find a cold newborn who isn’t breathing. They rush the baby to the hospital, but despite trying for an hour, are unable to revive the infant.
Addison called Darcy’s baby “Batgirl” because she made cry like a bat (“eee eee eee”) and liked the dark. As a comic book fan, I think this is a great name and I feel strongly that more children should be named for crime fighting librarians.
I was always taught that you don’t call a code on a hypothermic patient until their body temperature is normal because the heart conducts abnormally at low temperatures. Like many things I learned during residency, this should be taken with a grain of salt.
Otherwise, the code looked appropriate. I was pleased to see there was no attempt made to “shock the flatline.”

Dr. Sam Bennett and Dr. Naomi Bennett
Sam and Naomi are called by their priest to evaluate a sick nun at the convent next door. The nuns have been sequestered for 3 weeks, and 86 year-old Sister Helen has been sick for the past week. She has a high fever, tachycardia (rapid heart rate), tachypnea (rapid breathing), and an impressive macular rash on her trunk. Most of the other nuns also become sick and Sam and Naomi quarantine the convent. An infectious disease specialist identifies the disease as typhoid (probably better known as “typhoid fever”>, and due to the short incubation period of the infection, the doctors realize that someone — a typhoid carrier (like Typhoid Mary) — had been secretly visiting the nuns. Ultimately, they discover that the priest had struck up a friendship with one of the nuns and had been sneaking it at night for cooking lessons (literally, no double entendre here). The priest is the carrier of the disease and infected the nuns. With a course of antibiotics they all should recover.
The big problem here is that the show is confusing two similarly named but very different diseases: typhoid and typhus. The symptoms and course are most consistent with typhoid, but Sam refers to it at least once as “typhus.”
While typhoid can have a rash, the one shown is more consistent with the rash of typhus.
Both diseases can cause high fevers, tachypnea, and cough. Interestingly, both cause a slow heart rate, not the tachycardia seen in the show.
The show is correct in stating that the incubation period for typhoid is 10-14 days. However, they incorrectly state that typhoid is spread by “skin-to-skin” contact. Not quite: typhoid is spread by fecal-oral contact or contaminated food or water. This means that a certain priest wasn’t washing his hands well after going to the bathroom.

Tags: television medicine private practice newborn typhoid typhus

New Warriors #5 “Defiant, part 5”
Kevin Grevioux, writer
Paco Medina, penciler

Just to prove I’m not always negative, I’m going to take a moment to highlight a comic that has a well written medical scene.

After blunt force head trauma, a concussion is the most common type of head injury. Concussions are diffuse injuries and affect the entire brain. (for a longer discussion, check out my review of Stormwatch PHD #11).

More serious — and thankfully less common — injuries following head trauma are the hematomas and hemorrhages — bleeding on (or around) the brain. Intracerebral hemorrhages, or bleeding within the tissue of the brain, can occur after blunt trauma, but are not as common as bleeding just outside the brain. Subdural hematomas are the most common. These occur when there is bleeding and a collection of blood between the dura (the tough membrane that protects the brain) and the arachnoid — the middle layer of the meninges (the membranes that surround and protect the brain). The hematoma causes increased pressure within the skull which can be life threatening, as well as direct damage to the areas of the brain underlying the hematoma. An epidural hematoma is similar, except the bleeding occurs between the dura and the skull itself.

Hematomas that are small can be monitored closely and should resolve on their own. Larger hematomas, especially those causing life threatening symptoms, require surgical intervention. The blood needs to be drained and — if possible — the source of the bleed found and stopped. This usually requires a burr hole or a craniotomy.

Of course, I do have a couple of small nitpicks, all regarding the art. Overall — as always — Medina does a good job with both the action scenes and the quieter moments. However:
If our patient just had cranial surgery, she should have her head bandaged, not in a surgical cap.
The art suggests that her burns were most likely to her back, in which case having her lie on her back like that just seems cruel (of course, we don’t know how extensive the burns are, they could be small and inconsequential).
The heart tracing bears little resemblance to an actual heart tracing, even in a case of cardiac arrest (the one on the cover is fine, though).

*For spolierific reasons, I’m not going to name the character, though she is shown injured on the cover.

Tags: comics medicine new warriors concussion subdural hematoma epidural hematoma kevin grevioux paco medina

Episode Title: In Which Addison Finds the Magic

A show primarily about marriages this week. Pete and his dead wife. Violet and her ex-husband. Naomi and Sam doing more of their infighting. And Addison whining. Plus more bad ethics. I expect this from Dr. House, it’s his shtick, but not from these doctors who are supposedly better and brighter.

Dr. Cooper Freedman
Cooper is brought to see a young girl who is blue. Not depressed, as he thought initially, but the patient actually has blue skin. He asks about dyes, inks, or any topical compounds that could have dyed her skin, but there have been no exposures. There was no other chemical exposure, by history. He ultimately decides that she has methemoglobinemia (an abundance of chemically-damaged hemoglobin in the blood) and treats her, correctly, with intravenous methylene blue. He in unsure what exposure lead to her developing the condition, but she responds to the medication. Over the next day or two, her skin turns blue again, as does the skin of her three younger sisters. One of the girls has a seizure as well. Cooper and the mother search the house, but can find no source of toxicity. He eventually talks the girls into letting him spend the day playing with them and they lead him to their “castle” – a neighbor’s old shed filled with leaking bags of the fertilizer ammonium nitrate. Nitrates are a known cause of methemoglobinemia and the girls are inhaling enough of the fumes to make themselves dizzy and their skin turn blue.
Methemoglobinemia is rare. There is an inherited form of the disease, but the girls have an acquired methemoglobinemia. It is treated with oxygen and 5 minutes of intravenous Methylene Blue followed by a saline flush (a big bag of blue IV fluid shouldn’t just be left hanging like it was in the episode).
Other possible causes of methemoglobinemia include certain older antibiotics, local anesthetics, nitrates, and metoclopramide (Reglan). There are a few unusual household chemicals that may cause it. Well water with a high nitrate content has been known to cause methemoglobinemia.
Inhalation of ammonium nitrate generally causes a nasty headache, cough, and sore throat — symptoms that were missing but would have helped narrow down the type and route of exposure.
I find it hard to believe that a parent who chose to stay at home to raise her kids is not going to notice her four kids regularly disappearing from the yard like that?

Dr. Addison Montgomery and Dr. Pete Finch
Addison has a newlywed couple as her patients who complain that they cannot have sex. Any attempt causes severe pain to the wife. Addison attempts an exam, but even that is too painful for the patient to endure. She diagnosis her with vaginismus. She tries muscle relaxants first, but they do not work. Next she tries trigger point injections combines with guided imagery. That works miraculously.
Vaginismus is a real condition, and difficult to treat. It is almost always psychological in nature.
The best treatment for vaginismus is a combination on counseling, special exercises, time, and understanding. It rarely resolves overnight.
I’ve never heard of muscle relaxants being used as a treatment. I can imagine that benzodiazepines like Valium might work, but more for their psychological effects than the physical ones.
If her problem is indeed caused by overly-sensitive nerves, then trigger point injection might work. Her issues seemed much more psychological to me, though, so I suspect Pete’s therapy did the most good.
For a “world renowned” surgeon, Addison has some lousy bedside manner.

Dr. Violet Turner and Dr. Sam Bennett
Violet has a patient named Doug who is unhappy in his marriage and wants a divorce, but is scared to tell his wife. After three years of therapy, she has finally convinced him to stand up to his wife and tell her what he wants. When he does, his wife’s nose starts to bleed uncontrollably and he brings her to the clinic for evaluation and treatment. Sam is able to control the nosebleed, but the patient’s labs show that she has a moderate anemia (low blood count).
A day or so later, the wife confronts Violet and she once again begins bleeding. Not just a nosebleed this time, but hemoptysis (coughing blood). She is admitted to the hospital and diagnosed with Wegener’s Granulomatosis, a chronic disease caused by inflammation of the blood vessels. After a confrontation with the hospital chief of staff, Sam discovers that the patient has known she has Wegener’s for at least 6 months and never bothered to tell the husband. He and Violet confront both the husband and his wife with the truth, but in the end Doug chooses to stay in his unhappy marriage.
There are good treatments for Wegener’s now, but it can still be a fatal disease. Relapses occur in about 50% of patients, and about 80% suffer some variety of long-term complication (deafness or kidney disease, most commonly). Survival rates vary, depending on the study, but around 75-80% can expect to live at least another 5-10 years with treatment.
No chief of staff is going to overrule an attending physician like that. It’s bad form and it’s not her job. Plus, it will drive doctors from the hospital. Hospitals like doctors, they make them money.
The confrontation in the end may have been within the letter of privacy laws, but clearly against the intent. You don’t threaten patients into sharing information with each other. The wife should have refused to tell them anything and reminded Violet that she had been fired as her husband’s therapist, so her husband would not leave the room with her. (OK, ideally, she should have told her husband the truth in the first place, but how likely was that to happen?).

Tags: television medicine private practice methemoglobinemia nitrates vaginismus wegener’s

Stormwatch P.H.D. #11 “Family Matters”
Christos Gage, writer
Andy Smith, penciler

A concussion is a type of mild diffuse brain injury — this means that the injury is spread over a large portion of the brain as opposed to a focal brain injury such as penetrating trauma or a bleed. Concussions are most commonly caused by a direct blow, though acceleration/deceleration injuries can also cause them. Common symptoms include amnesia, headache, confusion, vomiting, visual disturbances, and a loss of consciousness. The amnesia can be retrograde (loss of memory from the period before the injury) or anterograde (loss of memory from the period after the injury).

There have multiple systems devised to classify concussions, but none have been completely satisfactory because they aren’t very good at what we as doctors (and you as patients) are most interested in: predicting outcomes. One of the more common of these systems divides concussions into five grades. Grade I is a concussion where the patient experiences confusion, but no loss of consciousness. Grade II includes anterograde amnesia in addition to the symptoms of a Grade I concussion. Grade III concussion have the symptoms of Grade II concussions, but also include retrograde amnesia and unconsciousness of less than 5 minutes. Grade IV is similar, but has a loss of consciousness of five to ten minutes. Grade V describes a patient with a concussion who remains unconscious more than ten minutes.

Two concerns in patients who suffer concussions are Post-Concussion Syndrome and Second Injury Syndrome.

As the brain is healing after a concussion, neurological symptoms including headache, dizziness, clumsiness, memory problems and light sensitivity can persist. These symptoms are known as Post-concussion Syndrome and can last for days, weeks, or even years (Jackson King is being a little overly optimistic when he tells Gorgeous that it will only last “a couple of days.” But then maybe he can predict the outcome better because of his telepathy — sure would be nice). Post-concussion syndrome can make returning to work, school, or sports a real challenge. For example, Steve Park was once a top tier NASCAR racer who suffered a severe concussion in a crash. He had a protracted post-concussion syndrome and was never able to race successfully at the highest level again. Patients who are experiencing post-concussion symptoms should not return to sports (or crime-fighting) until all the symptoms have resolved. (We generally recommend waiting an extra week after the symptoms have resolved just to be safe). Returning to full activity too early is a bad idea because 1) patients with post-concussion symptoms are apt to injure themselves, or at the very least, embarrass themselves by being very bad at sports (or crime fighting); and 2) the potential for Second Injury Syndrome.

If a person receives a second concussion while they are still recovering from a first concussion, they are at risk if developing a serious condition known as Second Injury Syndrome. Not much is known about this rare condition (less than 50 recorded cases) except that it seems to occur in young patients who sustain two mild head injuries within a fairly short period of time. Second Injury Syndrome is nearly always fatal, and even if the patient survives, they are likely to be severely impaired. There is no effective treatment or cure for Second Injury Syndrome.

Tags: comics medicine stormwatch concussion christos gage

Another classic from DC Comics, this PSA advises us to talk our conflicts out instead of fight about them…

…only it’s not really a particularly effective PSA, is it?

• The principal seems to be suggesting that they can fight anywhere else, just as long as it’s not on school property.
• The principal tells them to “find another way” to solve their conflict, but then doesn’t give any guidance as to what that method should be. Arm wrestling? 9mm Berettas? Drag racing? Dance Dance Revolution?
• Bert’s Dad is little better, spouting off about international peace, but not really giving any useful advice.
• It’s sad that a high school student has no idea how to resolve conflicts other than fighting, but then given the underwhelming abilities of his principal and his father, that’s no surprise.

Click on the image to the right for the full ad.

Tags: comics psa fight peace

Could someone please explain to me what the big deal about Harbinger is? I picked up the first handful of issues cheaply — including the #0 issue — about a year ago and finally sat down to read them a few days ago. I’d always heard it was a good and groundbreaking series, but to say that I was underwhelmed would be putting it mildly. At best, it’s merely a mediocre comic, eminently forgettable. It’s not horrible, but that’s not really a good selling point (feel free to use that as a pull quote on the upcoming reissue though: Doctor and comic book blogger Scott says “It’s not horrible.”). The characters are almost entirely two-dimensional stereotypes and the plot is meandering and poorly explained. For example, by the third issue, they’re fighting aliens on the Moon. Let me repeat that: aliens on the Moon — it’s like a bad Silver Age comic. To me, that’s not the mark of an awe-inspiring and groundbreaking comic.

The way I figure, this Harbinger discrepancy can be explained in one of four ways:

1. Harbinger is a great comic, and I am merely too unsophisticated to appreciate it. (Certainly possible; I do have low brow mainstream super-hero tastes).
2. Harbinger is not a great comic, but it was better than most other comics from the ’90s, hence its reputation as a quality comic.
3. People are looking back on the series with rose-colored glasses, but haven’t actually read it in years. When they actually sit down and reread the issues, they will realize it’s not nearly as good as they remember.
4. People are confusing perceived monetary value with quality (this is certainly the impression you get reading the Wikipedia entry on Harbinger). The two are not interchangeable, especially in terms of ’90s comics.

Anyway, on to the picture quiz. Tell me what’s wrong with this scene from Harbinger #1:

Previous picture quizzes

Tags: comics harbinger valiant comics picture quiz

This week’s example of a super power-related nose bleed actually has a logical basis in anatomy and physiology. (I know; I’m shocked too.) The scene in question comes from the recent Outsiders Annual #1 (Judd Winick and Scott McDaniels), where the team attempts to bust Black Lightning out of Iron Heights prison. They accidentally start a prison riot, which Warden Gregory Wolfe uses his super-powers to quell.

You’ll notice that several of Warden Wolfe’s victims are bleeding from the mouth. The warden has the super power to make muscles tense up and spasm. A sudden contraction of the jaw muscle could cause a severely bitten tongue and bleeding from the mouth. This doesn’t explain the nosebleed, though as there are no nasal muscles to spasm and cause a nosebleed. On the other hand, if most of the muscles throughout the body were contracted at once, this would lead to an increase in vascular resistance, and a subsequent rise in blood pressure. (If the warden’s powers can affect vascular smooth muscle, the rise in blood pressure would be even worse.) This high blood pressure could be enough to cause the nosebleeds. You would also expect to see an increase in the number of heart attacks and strokes as the blood pressure increased. This may explain the scene at the end of the fight when the warden totally unleashes his powers, killing dozens. Those deaths were probably caused by heart attacks from the incredibly high blood pressure (or the deaths could have been due to a severe spasm of the heart muscle, if the warden’s powers can affect the heart directly).

Final Thought: Shift tries to counter the muscle spasms by creating “a massive gas wave of high-octane muscle relaxant — calcium and magnesium.” While it’s true that certain magnesium compounds have muscle relaxant properties, and calcium ions are involved in muscle contraction and relaxation, I wouldn’t consider them particularly potent muscle relaxants. There’s also the chemistry to consider. Magnesium doesn’t readily become a gas at anything close to room temperature — its boiling point is nearly 2000d F (just over 1000d C). It’s also highly flammable — not a good idea in a firefight.

All previous Psychic and Super-Power Nosebleed Zen posts

Tags: comics medicine nosebleed outsiders

This nice example of a psychic nose bleed — and accompanying eye bleed — comes from Ms. Marvel #16, where S.H.I.E.L.D. psychic Agent Locke fires a “neural blast” to incapacitate the various members of A.I.M. and their monsters that she is fighting. It worked incredibly well, but also knocked her down for the count. I’m a little behind on my S.H.I.E.L.D. history — I remember that there were S.H.I.E.L.D. psychics (“ESPers”) shown during the the original Micronauts series (issues #25-28, the return of Baron Karza), and now Agent Locke and other psychic agents have been introduced recently. Was their any mention of S.H.I.E.L.D. psychics in the intervening twenty-five years? All previous Psychic Nosebleed Zen posts Tags: comics medicine nosebleed ms marvel shield

Armageddon 2001 was the big DC “event comic” of 1991. There were two bookend comics, Armageddon 2001 #1 and #2, at the beginning and end of the summer. In between, all the annuals (back with every series had an annual) tied into the storyline: in the not too distant future of 2001 (remember, this was written in 1991), the villainous Monarch has taken over the entire world and slaughtered all the super-heroes. The kicker is that he used to be a super-hero himself before becoming evil, but no one knows which hero. One of the citizens of the dystopic future uses experimental equipment to gain time-based superpowers. As “Waverider,” he can travel through time. He can also look into a person’s future just by touching them. He resolves to use his powers to travel back to 1991, the year when Monarch first appeared, and discover Monarch’s identity by looking into the future of each hero.

In Hawk & Dove Annual #2, Waverider appears just as Hawk and Dove have broken up a mugging. First he touches Hawk. He sees a future where Hank has become a member of Monarch’s Peacemakers, his powerful Brownshirt-like police force. Hank is unhappy because he realizes that the Peacemakers are no better than thugs and Monarch just a tin-plated despot. His attitude has already gotten him in trouble once when his superiors decided that Hank needs a little “re-education.” Hank takes this as an opportunity to turn into Hawk, for the first time in years, and face Monarch mano a mano. He explains to Monarch that he hasn’t been in hiding, but slowly and carefully building up his powers to become more powerful. Hawk transforms into a more powerful version of Hawk (who looks ridiculous, like a thick-waisted chicken-headed monster) and attacks Monarch. Despite all his added power, Hawk is still losing the fight when Dove rescues him by bringing him over to another dimension where she’s been hiding and building a resistance against Monarch.

Next, Waverider touches Dove — but unlike other heroes, her link to Order allows her to sense him and she realizes what he is doing. She takes control of Waverider’s powers and shows him three futures, which may or may not be linked. First, there is a council of war on a distant planet. Encouraged by an aged Dove, they agree to attack Monarch before he becomes an intergalactic problem. Second, on another planet (which looks to be Gemworld), Dove mourns a dead Hawk. She is also raising her child, who has some sort of magical powers. For the third future, Dove brings Waverider back to his own world of Armageddon 2001. In this future, Hank is married to Ren and Dawn to Captain Arsala. Hank and Dawn have realized that it is time to confront Monarch one last time. They realize that they are likely to die in the battle, and ask Ren and Arsala to raise their child (Hank and Dawn’s — or is it Hawk and Dove’s) in secret.

Finally, Waverider touches both Hawk and Dove together. In this vision of the future, a young, female, first-nameless Dr. Arsala is the top neurosurgeon of the time, good enough to catch the eye of Monarch. She is also a friend of Barter’s, and he gives her two special gifts that he says comes from her “real parents” who died fighting Monarch. He gives her a vial of Chaos (the essence of Kestrel he took from Ren back in Hawk & Dove #17) and a gem of Order (the blue gem Hawk fought in Hawk & Dove #25) and tells her to remember “unity.” Puzzled, Dr. Arsala talks to her father, the former Captain Arsala, who tells her that Barter was right — Hawk and Dove were her parents. He explains a little about her real parents to her, and how they gained powers by speaking a certain word. She remembers what Barter told her and speaks the word “unity” — and she is instantly transformed into Unity, who seems to have the powers of both Hawk and Dove. Her costume reflects both of her parent’s costumes, in color at least (purple instead of red or blue), though the actual design leaves much to be desired. She confronts Monarch and decides that she will use her super-powers combined with her neurosurgical skills to physically and literally change his mind.

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This comic, published shortly after Hawk & Dove #28 (the official “last issue”) is a fitting epilogue to the series. It follows the themes presented in the series, particularly after Hawk and Dove’s return from Druspa Tau, to their logical conclusion. The annual ties nicely into the continuity of the regular series with such things as Barter, the essence of Kestrel, and the Order gem. It also manages to fit into the Armageddon 2001 storyline in a logical fashion, better than any of the other annuals, and as far as I can tell it was the only annual that actually dealt with Monarch.

Sadly, the art was sub-par for most of the issue. The connecting sequences were by Curt Swan, and while better than his work on issue #28, I still don’t care for his take on Hawk and Dove. The Dove sequences were drawn well, but the Hawk and Hawk-and-Dove sequences could have used better pencils. The character designs, particularly of the supposed-to-be-impressive über-Hawk and Unity, were more silly than awe-inspiring.

All Previous Hawk and Dove Reviews

Tags: comics hawk dove armageddon 2001 monarch waverider unity barter

A convenient list of all the back-up strips I’ve featured over the past several years:

Dr. Dan Dazzler
Backup strip from Dell’s Ben Casey comic, featuring the adventures of the intrepid intern, Dr. Dan Dazzler

• Dial EMERGENCY… Dan rescues a young boy stuck in a hole, all the while obsessing on a crossword puzzle (from Ben Casey #2)
• Rumble..! Dan gets involved in a gangland fight (from Ben Casey #3)
• One Heartbeat from Death Dan rescues a man from downed power lines (from Ben Casey #4)
• Deadly Playmates Dan visits the circus and meets a few snakes (from Ben Casey #5)
• Open-Shut Case On vacation in the mountains, Dan is called on to rescue an injured hiker (from Ben Casey #6)
• 9 Lives Has Dr. Dazzler Dan has too much luck, both good and bad (from Ben Casey #7)
• I Can’t Breathe Dan and his first (and apparently only) date visit the zoo, where he treats a boy who swallowed some change (from Ben Casey #8)

Jungle Doctor
Doctor Frank Dale and his assistant Bob Rose travel around Africa as the “Jungle Doctor” in this series of backup strips from Dell’s Dr. Kildare comic.

• Who Will Be Chief? Dr. Dale and Bob assist in a matter of succession (and fist-fighting) in this story from Dr. Kildare #4.
• A Dangerous Game Dr. Dale and Bob break up a black market drug smuggling organization to save a village from jungle fever in this adventure from Dr. Kildare #5.
• Dangerous Waters In this story from Dr. Kildare #7, Dr. Dale rescues a family trapped on a raft in a raging river.

Tags: comics dell ben casey dr kildare dazzler jungle doctor

Apothecarius Argentum is a manga recently published by CMX. It concerns Primula, the princess of the medieval Kingdom of Beazol, and Argent, the local apothecary (a cross between a pharmacist, physician, and healer). Argent is a Basilisk — individuals who were purposefully fed potent poisons as children. They subsequently develop immunity to toxins and their touch is poisonous. Argent was originally a slave who was bought by the king to be his daughter’s food taster. Later, when he accidentally touched the princess while saving her life, he was sentenced to death but Primula let him escape. He has now returned to the kingdom years later as an apothecary.

The book is a good read. It contains four independent chapters which involve (as one might expect) poisonings, fights, and palace intrigue. Argent is an interesting character, and the princess and her father have potential, but still need more development. The art is competent, but not outstanding — it seems sketchy at times, particularly when the princess is the subject. The medical aspect is quite good as the writer worked as a pharmacist before becoming a mangaka. He provides some interesting endnotes. My main complaints are relatively minor. I wish the Kindgom of Beazol were better developed as it plays an important part of the narrative, yet seems no different than any other generic genre quasi-medieval kingdom. The book seems a little thin to me as well, at least compared to other manga. I’m not sure if it has fewer pages or thinner paper (or it might just be my imagination).

There are some minor spoilers below, so I suggest you read the manga before perusing my medical annotations…

Chapter 1
1. The symptoms of mercury poisoning vary depending on what form the mercury is in: elemental, organic, or inorganic. Symptoms can also vary based on the length of time of administration — was it a large dose at once, or many smaller doses over a long period of time? — as well as the route of administration (inhaled or ingested).

The villain tells the princess that he has been slowly and methodically poisoning her food, so she has chronic ingested mercury poisoning. Her symptoms match those of inorganic mercury (mercuric salt) poisoning. The princess’s complaints include nausea, vomiting, pale mucous membranes (the gums and inside of the cheeks), and edema in the arms and legs. Inorganic mercury poisoning causes ashen gray mucous membranes due to the deposition of mercuric salts. Gastrointestinal symptoms are common including nausea, vomiting, stomach pain, and even bleeding. Inorganic mercury poisoning can also cause a strange condition known as acrodynia. Patients with this have red palms and soles, as well as edema of the arms and legs. More severe cases can lead to hair loss, a peeling rash, and cardiac and neurological problems. Acrodynia is thought to be due to a mercury allergy. Based on the princess’s symptoms, Argent was correct, and she has a (conveniently) minor case of chronic inorganic mercury poisoning with symptoms that include early acrodynia.

Treatment of symptomatic mercury toxicity requires chelation. A special medication is given which binds to the mercury and allows the body to excrete it. The most common modern chelating agent is given by intramuscular injection, but there are oral chelating agents available as well.

2. Later in the chapter, Argent is poisoned with an arrow dipped in curare. The villain gloats over his downed body:

Curare is a highly potent poison derived from the vines of a tropical plant used by foreign savages. When struck by a poisoned arrow, it causes gradual muscular paralysis. You will soon die of respiratory failure!

The bad guy has it right. Curare was used as a dart poison by certain South American tribes. It is a potent muscle paralyzer — high doses cause asphyxiation because the victim’s respiratory muscles stop working. Modern medicine still uses curare and some of its derivatives as paralyzing agents before surgery or intubation.

3. Cowslip(Primula veris) is a common flowering plant in Asia and Europe. It has many reputed uses as medicinal herb, including use as a sedative, like Argent mentions.

Chapter 2
1. While preparing for a speech, the princess steps on a deliberately placed rusty nail. She soon develops a fever and becomes sick. Given the speed with which the infection hit, the nail was likely treated with some form of infectious agent. In the United States, whenever we hear “rusty nail,” we think of tetanus, but her symptoms and quick recovery do not match that disease. It makes me wonder if the “rusty nail equals tetanus” implication exists in Japan as well, or if its use was just coincidence (or a red herring).

2. Argent is right that sulfur gas can cause optical problems (blurry vision) and respiratory irritation. It doesn’t cause the respiratory arrest and death he threatens though. In the end, he admits that he is lying about the medication he gave, so he could easily be exaggerating about the effects of sulfur as well (or he might be confusing it with sulfur mustard, i.e. mustard gas, a chemical warfare agent first used in World War I.)

Tags: comics medicine apothecarius argentus manga mercury curare cowslip tetanus sulfur mustard gas

In 1990, the adult son of one of the Warner Brothers executives who worked with DC Comics was senselessly murdered. In response, DC published Batman: Seduction of the Gun, a comic with a strong anti-gun tone, and with the added bonus of the proceeds going to a charitable educational foundation.

In Gotham City, a drug-for-guns deal is going down. The police and Batman bust up the deal, but the main criminals — members of the NZN gang — escape. To capture the gang, Batman masquerades as a gun dealer while Robin enrolls in an inner-city high to protect the dealer’s daughter from gang reprisal. The Batman aspect of the story is a fairly typical Batman adventure with subterfuge, fights, and narrow escapes from death. The Robin part I found a little over the top, with Robin attending a school where over 95% of the students are armed, and gun fights in the hallways between classes are daily experiences. Admittedly, I didn’t attend an inner city high school, but this strikes me as more than a little unbelievable. Both stories converge in the end, but things don’t work out as well as Batman — and Robin — had hoped.

Overall, it’s a well done story and a PSA comic that actually appears to be in continuity. For the most part, it doesn’t hit the reader over the head with its message, though there is a page or two of talking heads looking directly at the reader and lecturing. We also learn way too much about the wounds that killed Thomas and Martha Wayne (“The bullet…struck the left lung and then the heart through the right ventricle, ruptured the superior vena cava and the aorta. The bullets struck back left ribs and flattened out, breaking the ribs…I remember a lot of blood. The hearts continued pumping for a bit.”). The story by John Ostrander contains the intense action-filled plot with a touch of pathos he seems to favor (and it works for him, his scripts hit a lot more than they miss). The Vince Giarrano art is a satisfying cross between Graham Nolan and Neal Adams. There are places where the art is particularly explicit and disturbing — bullet wounds, for instance — but I suspect that was the intended effect.

Online, I’ve seen this comic described as “pro-gun-control”, but I don’t think that’s really the case. I can certainly see where people might get that impression, particularly as the proceeds from the book went to an educational gun-control foundation, but in the last panels of the comic, Bruce Wayne tells Tim Drake that gun control is not the best option (“No law passed can change the human heart or open up a mind that is closed. We must give up the guns in our hearts and minds first.”). The story certainly takes a strong stand against the proliferation of handguns, but gun control is not specifically mentioned. To me, the comic seems more anti-guns-in-school, anti-gang, and anti-Saturday-Night-special than explicitly anti-gun or pro-gun-control, though I may be splitting hairs.

Tags: comics psa batman john ostrander

A better episode this week than the last few, though there were still some strange holes in the medicine. The soap opera wasn’t as good as the last few weeks though.

Nate, a brilliant but unpleasant teenager is competing in a speed chess tournament. He wins his game easily, but becomes suddenly violent after the match and starts pounding his opponent with the time clock until he’s unconscious. Nate then complains of a terrible headache.

Once admitted to the hospital, Nate is evaluated by Chase who brings his case to the rest of the team The initial differential diagnosis includes parasites (tests are negative), brain tumor (MRI is negative), toxins or drugs (tox screen is negative). Foreman suggests an adrenal gland tumor, but House suspects Nate is suffering from cluster headaches. House wants to start Nate on blood thinners and transcranial magnetic stimulation (there’s a lot of other treatments they should have tried first). Neither treatment works, and Nate continues to complain of his headache, as well as face, shoulder, and stomach pain — but these last ones are attributed to the multiple fights he’s been in recently (but what do stomach pains have to do with fights?).

House persists in his belief that Nate has cluster headaches. Cameron suggests hemochromatosis (an iron storage disease) but House points out that it wouldn’t explain the personality changes. Chase suggests hypothyroidism but House shoots the idea down explaining that Nate does not show any of the metabolic slowing seen with low thyroid levels. A ruptured dermoid cyst is mentioned as well, but no sign of it has shown up on any scans. House decides the best treatment is to give Nate psychedelic mushrooms because the psilocybin in them is thought to help with cluster headaches (i’d be interested in how House got his hands on a Schedule I Controlled Substance). The mushrooms do seem to help his headache, but also make him very horny. He flashes his equipment at Cameron — she is underwhelmed and in fact notes that he has hypogonadism (abnormally small underperforming testicles). Concerns now include a hypothalamic lesion or a craniopharyngioma. House wants a biopsy of Nate’s pituitary gland. While he is refusing the test, he becomes dizzy and passes out. Examining Nate, Chase notes that he is showing signs of jaundice — a sign of liver failure.

The differential diagnosis of liver failure is a long list. Diseases mentioned include Wilson’s disease (a disease of copper metabolism, but his copper enzymes are fine), cancer, primary sclerosing cholangitis (an inflammatory disease of the bile ducts), alcohol abuse and Ornithine transcarbamylase (OTC) deficiency – a genetic condition where the person has trouble eliminating excess nitrogen from the body). House orders a “hamburger test” (a large meal of meat because proteins contain lots of nitrogen), but the results are negative. He next orders the Young Guns to withhold all food from Nate to rule out Diabetic Steatosis (abnormal fat accumulation in the liver caused by diabetes). Nate becomes violent and when asked to produce a urine sample and pees on the floor. It turns out that he has quite a bit of hematuria (blood in the urine) that in case shows that Nate has also developed kidney failure.

The differential now includes HIV, hepatic fibrosis, MCADD (Medium Chain Acyl-CoA Dehydrogenase Deficiency — another genetic metabolic disease. Patients with this one get very sick if they skip meals), and Von Gierke Disease (also known as Type I Glycogen Storage Disease). The tests for all these conditions are all negative, but Chase does discover that Nate has a partial HPRT (Hypoxanthine-guanine phosphoribosyltransferase) enzyme deficiency that means he may have Kelley-Seegmiller Disease (better known as Lesch-Nyhan Syndrome). House decides to test Nate by purposefully getting him angry. He plays him in a game of chess while taunting him. In the end, House appears to lose the game, but Nate has a seizure. The team discusses possible diagnoses and House now fixates on Foreman’s suggestion of Amyloidosis. He starts Nate on immunosuppressants and starts looking for a bone marrow donor. In the meantime, Foreman performs a nerve biopsy looking for the signs of the amyloidosis, but the test is negative. House is unconvinced and sends Foreman back to do another biopsy. Meanwhile, a discussion with Chase turns House on to the actual diagnosis –- hemochromatosis. The bad personality has nothing to do with disease; Nate is just a jerk. The “eureka moment” came when House realized that Nate is unable to bend his thumb so he holds his chess pieces unusually. This is due to the iron deposition from hemochromatosis affecting his joint mobility. It’s a good news/bad news scenario: Nate should be able to control his hemochromatosis with treatment, but he’ll always be a jerk.

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I thought the medicine was better this week than the last few weeks, but still not as good as it’s been in the past. There was a great deal of jumping from one diagnosis to another without good flow. The whole “cluster headache” idea was handled poorly. His symptoms did not fit the condition. Steroids are not the main treatment of cluster headaches, and not everyone with cluster headaches have puffy eyes. There are many more treatments they should have tried, especially triptans and oxygen. The amyloidosis seemed like quite a stretch. Simple blood tests should easily show hemochromatosis, and I’d also suggest a liver biopsy , which is generally a good idea when there is liver failure with an unknown cause. At the very least, a liver ultrasound or CT scan should tell quite a bit, like whether there’s a fatty liver or not. I liked how the diagnosis rested on a symptom shown in the very first scene, but I’m puzzled shy why no work up was ever made of all the aches and pain he had.

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I give the medical mystery a B, because it was fairly interesting (though I laugh at House telling Cameron that there is always a single solution). The final solution I give an A. It was clever and actually telegraphed for one. The medicine earns a B-. Better than it has been, but it still should be better. Hemochromatosis should have been found much quicker, and they need to go back to school to learns more about cluster headaches. The soap opera was fair and earns a B.

The previous House review
A list of all prior House reviews

A psychic nosebleed two-fer this time. In a previous post, we saw Nate Grey’s nose start to bleed when he got too near to Cable, since apparently meeting your alternate dimensional self causes a nosebleed — or at least it does if your both psychic. In X-Man #14, Nate Grey and Cable join up to fight Exodus (talk about your consummate ’90s villains — Marvel should have just let him remain forgotten instead of bringing him back post-House of M). Because they are in such close proximity to each other, both Nate and Cable end up with a bit of a nosebleed (and an ear bleed too, in Nate’s case). Have you noticed how Nate always seems to get the worse of it whenever he encounters Cable? Remember he’s supposed to be the more powerful mutant. I guess that’s a corollary to the rule about meeting your alternate dimensional psychic self: whoever is the stronger telepath will bleed more. You’d better get a pen and write that down — you never know when it might come in handy. All previous Psychic Nosebleed Zen posts Tags: comics medicine nosebleed nate grey cable

Another “just average” episode of House. I’ve come to expect more exciting and improbable medicine, and the show is just not delivering lately. To some extent, tonight’s episode was an ethics episode instead of a medical episode, and as such, it was still average.

Matty and Nick are brothers. Nick is fourteen and has leukemia. He has received total body irradiation to kill off his own bone marrow so that he can receive a transplant from his younger brother Matty, who is a perfect match. On the day of the procedure, Matty is found to be sick: he is sneezing and has a fever and an enlarged spleen. House’s team has only a few days to find out what is causing Matty’s infection and get him cured so that he can donate his blood marrow before his brother dies.

The team decides to make him sicker so that it will be easier to find the cause of the infection. They expose Matty to cold, wet condition and they also remove his white cells (the infection-fighting cells of the blood) through leukophoresis. Matty is getting sicker, but no clear causative agent has emerged. In addition to a snotty nose, Matty complains of a sore right shoulder and a swollen testicle. House suspects Matty’s acute scrotum is infectious and has the team runs tests for E. coli, tuberculosis, Brucella, Klebsiella, and entero- and adenoviruses. The tests all turn up negative (which really is no surprise as an acute scrotum in a ten year-old is unlikely to be infectious). Looking over other test results, Chase notes a high CKMB (an enzyme that is often elevated with heart damage or injury). A transesophageal echocardiogram is obtained and shows a thickened mitral valve. The team believes that Matty has bacterial endocarditis and that this is the source of the infection. The normal treatment for endocarditis is several weeks of antibiotics, but House decides to rush things. He wants Matty’s mitral valve to be surgical removed and replaced to eliminate the source of infection. He believes that this will allow Matty’s bone marrow to be ready in time to donate to Nick. Of course, Matty will probably end up on blood thinners for the rest of his life (depends on whether they would use a mechanical valve or a porcine valve).

As the surgery is being performed, Wilson discovers that the mitral valve growth is fibrous and not infectious and the surgery is called off. The team now suspects that Matty’s condition may not be infectious, but instead an autoimmune disease such as Lupus or Behçets Disease. Tests show no evidence of autoimmune disease.

Meanwhile Nick has started to bruise, suggesting that he needs the bone marrow transplant fast. Foreman suggests pressing ahead with a partial match donor, but House and Wilson believe that there is too much of a risk of graft versus host disease.

Matty is now bleeding from his ears and his blood counts are dropping. Whatever infection he has is suppressing his bone marrow — or it could be the medicine he’s on that’s suppressing the marrow.

The partial match bone marrow transplant is carried out, but Nick has developed high grade graft versus host disease and the medication is not controlling it. His prognosis is very poor.

The team stops Matty’s medication, but there was no bone marrow recovery, so it is unlikely to be the medication’s fault (though they only waited a few hours and it can take days for medications to clear the body, particularly in ill patients). Blood cultures are negative. Knowing that Nick’s condition is fatal and he is immune suppressed, House wants to expose him to Matty’s infection so they can get a better chance to identify it. The parents refuse. Wilson and Foreman continue to run tests on Matty, hoping to find the cause of the elusive infection. In the meantime, House talks to Nick and convinces him to save his brother’s life. Nick agrees to play incubator to Matty’s germs. Luckily, at the last moment, Wilson and Foreman have discovered that Matty has contracted histoplasmosis, a fungal infection he developed because his house was built on farmland and he was exposed to soil from an old chicken coop. Matty should be cured with a course of Amphotericin B. The parents ask if he’ll be better in time to donate bone marrow to Nick. Cuddy sadly tells them no, that the infection has weakened Matty’s bone marrow too much. This doesn’t stop Foreman: he straps Matty down and performs a painful bone marrow collection procedure (which seems to contradict what Cuddy just said). It all ends happily, with both brothers recovering and living happily ever after (one presumes).

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The medicine was mediocre, and I expect better from House. The mystery was good and the solution logical, but there seemed to be a great deal of forgotten symptoms (and/or red herrings) this episode: shoulder pain, the increased CKMB, and acute scrotum for starters. At the very least, the team needed to ultrasound his testicle to rule out testicular torsion, a devastating condition. Histoplasmosis generally causes only mild disease in immunocompetent patients; diffuse disease occurs in immunocompromised patients (such as AIDS patients). Of course, Matty’s white cells were removed so that did compromise his immune system — but fungi are slow growing so it would take at least several days to see any response (and similarly it would take at least several days of Amphotericin to treat the infection, not one dose then slap him down and take his bone marrow). Taking his white cells may have seemed a good idea in theory, but really wasn’t a good idea in practice. For one thing, white cells are responsible for many of the signs of infection we look for such as fever. The contradiction between what Cuddy told the parents and what Foreman did right after didn’t help the storyline either. And I hope I don’t need to mention that Foreman’s actions were entirely unethical. He needs informed consent, and a ten year-old is way too young to truly understand the risks and benefits of the procedure. What Foreman did was no better than assault and child abuse. So as not to end on a downer, the show’s portrayal of Nick’s acute graft versus host disease was well done.

There were a bunch of stupid lines that stood out badly in this episode. First was House’s contention that narrow spectrum antibiotics work faster than broad spectrum ones. The spectrum of the antibiotic has nothing to do with its speed, they’re unrelated. Then there was Cameron’s claim that Matty’s blood was “literally turning into water.” Even if there aren’t many blood cells left, there are still plenty of other proteins, enzymes, and chemicals in blood to make it a lot more than water — I sure wouldn’t drink it. Finally, there was Foreman’s statement that Matty was too sick for sedation. That’s simply ridiculous. Collecting bone marrow without analgesia is a hell of a lot harder on the body than anesthesia — or at the very least pain medicine — would be.

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I give the medical mystery and the solution both a B. Like last week, the medicine was haphazard and and just average, which is why it earns a weak C. The House/Wilson/Hector soap opera was good, but the Foreman scenes were too heavy-handed for my taste. I give this aspect of the show a B as well as an N (Needs more Cuddy).

The previous House review
A list of all prior House reviews

Tags: television medicine house leukemia bone marrow transplant histoplasmosis

Frankly not a good episode tonight — in fact, I gave it a failing grade. There were too many missteps and some appallingly misunderstood medicine. See if you agree — or can show what I’m missing…

Jasper, a very rambunctious eight year-old boy, has just been a fight and received a bloody nose and his father has been called to day care. While his father is stopping the nosebleed, his six year-old sister Lucy collapses and is struggling for breath. She is admitted to the hospital and found to have a restrictive pericarditis (the sac around the heart becomes too tight to allow the heart to correctly fill with blood) and elevated blood pressure. She undergoes surgery to remove the pericardial sac. Differential diagnosis includes bacterial infection, viral infection, amyloidosis, sarcoidosis, hemochromatosis, and tuberculosis. Blood tests are negative, but the perciardial sac shows granulomas which are thought to represent a fungal infection. House wants a lymph node biopsy to determine which fungus (but why not just test the granulomas themselves?), but the test is negative suggesting that there is no fungal infection. As the biopsy is being performed, Lucy develops double vision which is ultimately diagnosed as uveitis.

The differential now includes autoimmune disease such as Lupus, Kawasaki’s Disease, and JRA (Juvenile Rheumatoid Arthritis). Lucy is started on steroids to treat the presumptive JRA. While Foreman is talking to the father, she develops a left-sided facial droop and is diagnosed with a middle cerebral artery stroke. She is started on tPA (a “clot busting” drug used to break up the clot that caused an acute stroke or heart attack. Not approved for use in children, but I’m not sure what else one could try). She is noted to be polycythemic (her blood is too thick because there are too many red blood cells), and is started on hydroxyurea (a drug used to treat polycythemia vera — one particular type of polycythemia that the team doesn’t even know whether Lucy has) as well as therapeutic phlebotomy (blood letting).

When Cameron and Chase are searching the house looking for carbon monoxide (a cause of polycythemia), they come across a bloody t-shirt hidden in a vent in Lucy’s room. They are concerned Lucy might be the victim of child abuse. A vaginal exam reveals shallow cuts around the vagina, but no evidence of penetration. Ultimately the team discovers that the blood is menstrual blood, and Lucy had started her menstrual cycle…at age six (the shallow cuts are from her attempt to shave her pubic hair off with Dad’s razor). The team now considers a tumor a likely cause, especially a pituitary adenoma (a type of hormone secreting brain tumor) or an ovarian tumor. Cameron suspects that Lucy has been exposed to excess estrogen from the environment.

An MRI shows no tumors in the brain, but it does show what appears to be a tumor on her ovary — however it ends up just being a cyst. While the cyst is being biopsied, Lucy slips into ventricular tachycardia, but is successfully revived (just once on House, I’d like to see an episode where a patient does not have v-tach during surgery. I promise you, codes during surgery are very very rare. At least Foreman used correct pediatric setting for the defibrillators.)

Meanwhile, her eight-year old brother Jasper had been hitting on Cameron. When he goes so far as to attack Chase in jealousy, House realizes that Jasper is also going through precocious puberty. His testosterone is measured and is sky high.

Lucy now complains of abdominal pain. Scanning shows new cysts in her pancreas, kidneys, and lungs. Cameron is now convinced that the others were right and that it is a pituitary tumor (just one that won’t show up on an MRI). She wants to remove Lucy’s pituitary and even talks the dad into agreeing to the procedure. House is not convinced about the tumor; he now agrees with Cameron’s original assertion that there has been an environmental hormone exposure. He goes to the daycare center the kids attends and talks to their teacher. He discovers that she has been having a relationship with their father. She has also had a recent lip wax to remove excess facial hair. House puts all the clues together and deduces that the father has been using a non-prescription testosterone cream. Even though he has been careful about applying it only at the gym, the excess hormone has seeped through his pores, exposing his children to high levels of testosterone (and the day care teacher too), causing their symptoms.

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Medically, this episode was very scatter shot, with symptoms not matching up with the diagnoses. I’ll agree that excess testosterone can cause polycythemia, which can lead to a stroke. However, I can find no connection between testosterone and restrictive pericarditis, or testosterone and uveitis. Nor do I understand why high testosterone would cause randomly appearing cysts. More importantly, I cannot understand why testosterone, a hormone that leads to male sexual characteristics (e.g. the teacher’s hairy lips) would cause early menstruation. If anything, high levels of exogenous sex hormones would shut down Lucy’s pituitary/ovary axis by feedback inhibition. Frankly, I’m also skeptical of the excreted-though-the-pores scenario, but I can’t find any good studies. Testosterone is a complex chemical and not excreted in any meaningful amounts through pores (my sources indicate excretion is 90% urine, 10% feces).

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The medical mystery was fair — and I liked the red herring of the mother’s brain cancer — so I’ll give it a B. The ultimate solution, while clever, simply did not fit the majority of Lucy’s symptoms. I’ll give it partial credit, but only a D+. The medicine had too may unexplained symptoms and the confusion over male/female hormones dropped the score to a F (if anyone can show why I’m wrong, I’ll certainly re-evaluate). The soap opera aspect was better than last week’s (thanks to the Cuddy/Wilson play angle) and earns a B+.

The previous House review
A list of all prior House reviews

Tags: television medicine house precocious puberty restrictive pericariditis stroke uveitis

Batwoman (Kate Kane) is bound to an altar to be sacrificed by Bruno Mannheim, the leader of Intergang. Renee Montoya, Kate’s lover and the new Question, rushes in to rescue her.

With Kate bound on the altar, Mannheim drives the sacrificial blade into her heart. This is quite an impressive feat. The blade appears to be a fairly wide blade, yet he drives it vertically into her chest. Remember that the heart is protected by a little something known as the rib cage. Mannheim would have to drive the blade through a rib or two to reach her heart — and maybe even the breastbone — no easy task.

Kate tells Renee not to remove the blade. On one hand, this is good advice. The blade is plugging the hole it made and removing it will let blood pour out of the heart. On the other hand, blood loss is only part of Kate’s problem. The blade is large enough that it would have severely lacerated the heart muscle. The heart is a very efficient pump and contracts concentrically to push the blood through the arterial system. A large laceration will disrupt this contraction and compromise the heart’s ability to pump blood. Additionally, the knife probably severed one or more of the coronary arteries — the arteries that supply the heart muscle itself with blood. A severed coronary artery deprives the muscle beyond it of blood causing a heart attack. The knife wound would also disrupt the electrical conduction of the heart, further compromising its ability to function. Finally, the trachea, lungs, and esophagus may have been injured as well — and seeing the blood oozing from Kate’s mouth — probably were. In real life, without immediate resuscitation and surgery, this would be a mortal wound.

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Fatal wound or not, Kate is able to sit up, wrench the blade from her heart (and rib cage) and throw it at Mannheim.

Even accepting the comic book truism that all thrown weapons land blade-first, this is still an impressive throw. Despite being weak from her injury, she is able to bury the blade hilt deep in Mannheim’s back — remember that little thing called the rib cage? Kate manages to cut through it with a thrown knife. Her throw looks like it landed a little right of center, so she would have missed his heart. However, given the amount of blood shown in a later image, she probably cut through one of the major blood vessels such as the subclavian artery or vena cava, which would also be a mortal wound. I think it’s safe to say that severe lung damage would have occurred as well.

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I’m generally a big fan of Darrick Robertson’s art (way back from his time on the New Warriors) and his last go on 52 was some of the best pencils of the series. The art this time is not nearly as good — far too dark and scratchy – and looks like it was rushed. It costs the fight scene much of its excitement. There’s also the matter of the magically shrinking altar. When the scene starts, the altar ends a good foot above Kate’s head; her arms are resting on top of it. At the end of the scene, the altar now ends at the top of Kate’s head with her hair and arms dangling off the edge. Personally, I blame Darkseid.

Tags: comics medicine batwoman renee montoya the question 52

In the excitement of having an actual day off work last Friday, I neglected to post the last review of JSA Week.

JSA #18 “Injustice Be Done, part 4: Into the Labyrinth”
Geoff Johns and David Goyer, writers
Stephen Sadowski, penciler

This issue pretty much picks up where issue #17 left off (the intervening issue #18 was a flashback issue). Mr. Terrific decides against performing surgery himself on the wounded Sentinel (thank goodness) and rushed him to the hospital:

Mr. Terrific: Start an I.V. Two liters of Lactated Ringer’s over the next twenty minutes and type and cross for six units of whole blood

Lactated Ringer’s (abbreviation LR) is a commonly used intravenous fluid. It contains sodium, chloride, lactate, potassium, and calcium. Other common intravenous fluids include Normal Saline (abbreviated NS), a 0.9% w/v sodium chloride solution, and Half-Normal Saline (½NS), a 0.45% w/v sodium chloride solution. Different physicians will go to great lengths to tell you which fluid is better for which situation, but I have always found the debate more academic than practical.

As a nitpick, most clinicians would have phrased it “2 liters Lactated Ringer’s wide open.”

When practical, it is always best to transfuse blood that matches the recipient’s blood. To check this, a type and cross is performed. The donor blood is matched to the recipient’s blood type (the “type”) and an antibody screen is checked (the “cross”). Cross-matched blood minimizes the risk of transfusion reactions. A type and cross takes time though, up to forty-five minutes. In emergencies, non-cross-matched type O blood can be given.

Sentinel has been bleeding heavily for quite some time. I think he’d benefit from some type O blood initially, followed by cross-matched blood when it becomes available. Speaking of blood transfusion, whole blood hasn’t been used for years; instead, PRBCs (packed red blood cells) are given.

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Meanwhile, Dr. Mid-Nite has seen the true face of Johnny Sorrow and collapsed. Black Canary cannot find a pulse and begins CPR.

Black Canary: Mid-Nite! Oh Thank God! I thought you were –
Dr. Mid-Nite: Damn Close. Definite myocardial infarction. You give good C.P.R. Canary.

A myocardial infarction is fancy doctor-speak for a heart attack. Dr. Mid-Nite is saying that the sight of Johnny Sorrow’s true face caused him to have a heart attack. And not just a minor heart attack either, but one that actually caused his heart to stop and required CPR from Black Canary.

Heart attacks, even small ones, are serious. Part of the heart has died, and will not grow back. This can lead to all sorts of problems from arrhythmias to heart failure. It is not a good idea for Dr. Mid-Nite to get up and resume fighting crime immediately after the heart attack. Doctors have several names for patient’s like that: a charitable one would be “non-compliant,” a better one would be “idiot.” I’m not saying that patients with heart attacks are doomed to the life of an invalid — far from it — but they need to take it easy immediately after the attack because this is when the risk of complications is the highest.

Other issues: How exactly did Dr. Mid-Nite diagnose his heart attack? Does he have an EKG wired in his suit (OK, he probably does). What about treating the heart attack? I know he carries bottles of controlled substances in his costume, but what about drugs commonly used to treat heart attacks such as clot-busters, blood thinners, or nitroglycerin (the medication, not the explosive)? Don’t tell me he doesn’t at least have an aspirin in there. (Admittedly, Mid-Nite’s heart attack was caused by “fear” — whatever that entails — so clot-busters and blood thinners may not be appropriate. Aspirin and Nitroglycerin would still be a good idea though).

Tags: comics medicine jsa dr. mid-nite mr. terrific transfusion myocardial infarction

This is the first post of JSA Week — looking back at some of the science and medicine shown in the early issues of JSA.

JSA #6 “Justice, Like Lightning…”
David Goyer and Geoff Johns, writers
Marcos Martin, penciler

Black Adam comes tearing into town and picks a fight with the JSA. Black Canary (back before she regained her sonic scream powers) sneaks up behind Adam and places one of her “Canary Cry” screamers in his ear:

Black Canary: Since we’ve got special ear plugs — let’s see what 300 decibels does to your heightened hearing at close range.

A decibel (dB) is unit of ratio. It uses a logarithmic scale so small numbers can represent a large difference in effect. The most common use of decibels is to describe the intensity of a sound.
(Now remember that a sound wave is actually a compression wave, and that while the eardrums are the most sensitive part of the body to sound, they are not the only part affected by strong sounds — as anyone who’s ever “felt” the bass at a rock concert can attest). So how does Black Canary’s 300 dB Screamer rate?

decibel	event	effect on human body
40	Whisper
60-70	Normal conversation
100	Average car stereo
116		Human body (not just the ear) perceives low frequency sounds
120-130	Front row at rock concert	Tinnitus (ringing in the ears) begins
140		Pain threshold (hearing is painful)
145	Formula 1 race car	Vision becomes blurry
152		Joints are vibrating and painful; difficult to swallow
160	NHRA dragster
163	Minimum glass breaking level
165	Boeing 727 take off	Air begins to heat up due to compression
190-195		Eardrums rupture 50% of time
194	1 atmosphere of pressure. At this level and higher, sound waves begin to act like shock waves
200	Richter 1.0 earthquake	Human death from shock wave
212	Sonic boom from jet
220	Saturn V rocket launch
230	Richter 4.0 earthquake
240	F5 tornado
243	Largest non-nuclear explosion
257	1-megaton nuclear bomb
286	Mount St Helens 1980 explosion
300	CANARY CRY “SCREAMER”
302	Tunguska event (estimated)

Oops. Looks like the screamer’s a little too powerful — stronger than the shock wave from a 1-megaton nuclear bomb.

I think those ear plugs are probably a moot point.

Tags: comics medicine jsa black canary

A request has been made for me to review New Excalibur #17 which details Talia’s recovery from her stroke. First, however, I’d like to take a look at New Excalibur #16, which features the stroke itself.

New Excalibur #16 “Fallen Friend, part 1”
Chris Claremont, writer
Scot Eaton, penciler

In Excalibur #16, Talia (Nocturne) suddenly suffers an apparent stroke. Visiting Dazzler in the hospital, she suffers a sudden loss of coordination, headache, numbness of both arms and legs, and then unconsciousness.

Generally speaking, there are two types of strokes. The most common (80%) is an ischemic stroke, where blood flow to one of the blood vessels in the brain is blocked by a clot. This prevents blood from getting to part of the brain, and this part will almost immediately stop functioning, and will die if blood flow is not restored quickly. The leading treatment for ischemic strokes are clot-busting drugs (also known as thrombolytics), but they have to be given within 3 hours of the onset of symptoms. Blood thinners may be used to prevent a subsequent stroke,

The second type of stroke is a hemorrhagic stroke, where one of the blood vessels in the brain starts to leak or bleed. This causes damage in several ways. First, the brain tissue beyond the bleed is denied its blood supply and can die, just like in an ischemic stroke. Second, blood is irritating to the brain tissue which causes swelling and inflammation. Third, if enough bleeding occurs, it can raise the intracranial pressure which can restrict blood flow to the entire brain. The treatment of a hemorrhagic stroke should come as no surprise: stop the bleeding. This may require surgery. Additionally, if a large amount of blood has collected, it may need to be surgically drained. Since the treatment for an ischemic stroke, clot-busters and blood thinners, will make a hemorrhagic stroke worse, you need to be sure what type of stroke has occurred before treatment is started.

So far, it’s not clear which type of stroke Talia suffered. Given her headache and loss of consciousness, a hemorrhagic stroke seems more likely as these are symptoms of increased intracranial pressure. However, no mention has been made of any surgery or neurosurgical evaluation. On the other hand, no mention has been made of thrombolytics or blood thinners either, though when Sage explains what a stroke is to Pete Wisdom, she only mentions ischemic strokes. Frankly, I’d be surprised if we ever find out for sure what type of stroke she had.

Doctor: Set up a fell series of x-rays — chest and skull. MRI’s as well — someone find out if we have to worry about her super-powers? And check with her teammates, she’s got different hand and feet structures, blue skin and weird eyes — are there any internal differences we need to know about?

I’m not certain why the x-rays were ordered. Talia was showing neurological symptoms and then she lost consciousness. The differential diagnosis would include stroke, seizure, hemorrhage, drugs, infection, or metabolic disorders — none of which show up on x-ray*. There is only a limited time window to treat a stroke, particularly an ischemic stroke, so there is no need to waste time getting unnecessary x-rays. An MRI makes sense because it has a good study for showing a stoke, either ischemic or hemorrhagic.

It’s nice to see a doctor taking super-powers into account , one would presume both for his sake as well as the patient’s. It’s what I would expect to see in a comic book hospital. Of course, in a comic book universe, we should probably add “telepathic disorder” to the differential — but then again, she doesn’t have a nosebleed, so maybe not.

Tomorrow: The requested review of New Excalibur #17 (plus I believe #18 is available in stores UPDATE: Oops. Not yet)

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*to be fair, “trauma” would also be on the differential – and that would seem a likely possibility in a superhero who had recently been in a fight — and while trauma should show up on x-ray, it would show up on the MRI as well, so there’s no reason to waste time getting an x-ray. (Plus the x-ray wouldn’t give a good view of the brain itself, just the skull. ) Just go straight to the MRI (or CT).

Tags: comics medicine excalibur chris claremont stroke

In the midst of Hawk’s crime spree, this issue takes a look back at when Dawn first learned Hawk’s secret identity.

Dove swings by Hank’s apartment, but he’s not there. She let’s herself in — he didn’t hide the key well — and sits to wait for him. While she’s waiting, the answering machine picks up a call from Hank’s dead brother Don and she begins to get an idea of what Hawk’s been up to.

Dawn fixes a cup of coffee and remembers when she first heard that Don, the original Dove, was dead. She was in England and had just helped capture some crooks when a police officer mentioned how sorry he was to hear that the other Dove had died. With his comment, Dawn realizes that she is the only Dove and decides that she needs to find Hawk.

She travels to Dove’s memorial service. There, she sees Cyborg, Wally West, and Hank Hall, among others. When Hank makes a comment about his dead brother Don, Dawn realizes that he is Hawk — but she doesn’t know his name. Looking back, she also realizes that Kestrel was there even then, looking for Hawk.

Dawn follows when Hank leaves. She can see that he’s becoming wilder and less restrained in his actions. For instance, when he fights a redneck cyborg named Turbeau (really), he leaves him drowning in the river after the fight.

She tracks Hank down to a hotel and manages to connive his name out of the night clerk. Once again hot on Hank’s trail, she stumbles across Turbeau’s jailbreak. She has to decide whether to follow Hank or stop Turbeau — but it’s not much of a decision. She knows Hank’s name now so she figures she can always find him later. Dawn changes into Dove and with a single penny is able to stop Turbeau in his tracks.

Back at Hank’s apartment, morning has come and still no sign of Hank — except for the morning paper which bears the headline “Wanted: Hawk Hunt Begins!’

Flashback issues are usually disastrous, introducing new characters that the heroes supposedly have always known (like Hush, or that Molten-Man wannabe over in the Amazing Spider-Man). This one actually follows established continuity and manages to fill in a few holes, but still is rather a dull read. The art is good, particularly the design of Turbeau (and speaking of Turbeau, I can’t decide whether his creation was stupidity or genius, but I’m leaning toward the latter — c’mon, he’s a redneck cyborg!). With the several mentions of Kestrel this issue, one gets the idea the writers were setting up his return, but with only two issues (and one annual) left, never got the chance to follow through. (He did re-emerge for two issues of the current Teen Titans series, but it’s yet to be explained how he returned since the last we saw him Barter had his essence in a jar.)

All Previous Hawk and Dove Reviews

Tags: comics hawk dove kestrel

I felt this was the weakest scene in the whole comic. First, it doesn’t sound like Reed Richards — it sounds more like bad Braniac-5 fanfic*. Second, that whole “adrenal glands” comment just struck me as awkward. It’s not necessarily wrong, just graceless.

The adrenal glands are located just above the kidneys. Among the many hormones they produce is epinephrine (better known as adrenaline), the chemical that activates the fight-or-flight response. Adrenalin is produced at the direction of the brain when the body experiences certain kinds of stress. So I guess Reed is saying the seeing Sue stresses him to such an extent that it activates his fight-or-flight response and makes it hard to communicate romantically. That’s entirely likely — from personal experience I can tell you that seeing the person involved in a bad break-up can cause those feelings.

But why mention the adrenals at all? Why not blame the locus ceruleus or the other areas of the brain responsible for activating the adrenal glands in the first place? Why not just say “it hurts to see her” and leave it at that. And while the fight-or-flight response might cause some problems, I think the bigger problem is the anger and betrayal they feel with each other and you can’t blame the adrenal glands for that. The way it’s written, it makes Reed sounds like someone trying to seem smarter than they actually are by using big words that are close, but not quite right. And that’s not Reed — he may use big words, but he uses them correctly (usually).

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*“I…will…always…love…you…Quer-” she gasped. Taking a final ragged breath of the thin air, she clutched at my arm and then was still.

“You shouldn’t have, Mary Sue,” I said feebly to her lifeless body, the rising wind tousling her long blond hair. “That death beam was meant for me.” I realized that my computer-like brain was unable to deal with the rush of emotions I felt. I cursed my unfeeling ancestors of the planet Colu and their emotionless breeding program. Gently I closed her eyes, which before had always shown the most brilliant azure blue but now had slowly faded to dull gray in the light of the setting suns. I clung to her body until it became cold and then I buried it on that barren world.

I returned to my lab and cried for a full ninety-three minutes.

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Or maybe Reed has just been listening to too much “Death Cab for Cutie” and now he’s going to run home and blog about it. Reread his captions above, but this time imagine them on some overly dramatic MySpace blog or LiveJournal.

Tags: comics medicine civil war reed richards adrenal gland braniac-5

The Amazing Spider-Man: Riot at Robot World was published in 1991 by Marvel Comics and the National Action Council for Minorities in Engineering, with a grant from IBM to commemorate National Engineers Week.

Peter Parker is assigned by the Daily Bugle to cover Robotworld, the new museum/exhibition hall that just opened, designed to educate the public about robots. He meets with Ana Lopez, a mechanical engineer and the project’s head, as well as three high school students who are accompanying her. The group tours the exhibition while they educate Peter on what exactly robots are (scientific genius Peter Parker does show a slight case of ONISGS Syndrome here).

About halfway through the exhibit, the robots suddenly come to life and begin attacking. Peter dodges out of sight (”I need more film”) and returns moments later as Spider-Man. He fights robot after robot, including the giant Tyrannosaurus rex featured on the cover. Meanwhile, Ana and the students run to the control room where they find that Ultron has taken over the exhibition. When Spider-Man arrives in the control room and faces off against Ultron (very unsuccessfully and very painfully), Ana and the students use the distraction to rig a remote control box and shut down Ultron.

I’m of two minds about how easily Ultron was defeated. On one hand, as a long time Avengers fan, I am appalled by how quickly he was taken out of commission. It takes the Avengers at least three issues to defeat him, and he always comes back stronger than before (though the remote control shut off is a clever way around that whole adamantium armor issue). On the other hand, I can see how an engineer and a group of students shutting down a big bad guy by building a remote control would be appealing and inspiring to high school students interested in engineering.

Overall, this PSA comic is better than most. Writer Dwayne McDuffie writes believable characters and includes the clever quips we expect from Spider-Man. He also manages to throw in allusions to Buckminster Fuller, Isaac Asimov, the Terminator, and the Three Stooges. The penciler, Alex Saviuk, turns in some impressive art as he make excellent use of visual flow, perspective, and angles to give the book an exciting fee — unusual for a PSA comic.

Tags: comics psa spider-man robot dwayne mcduffie alex saviuk

1. All-Star Detective Comics
Emphasis on the word “detective.” Each would be a done-in-one mystery story starring Batman, Elongated Man, Jason Bard, or any one of DC’s other great and not-so-great detective characters. Writers would “play fair” with the clues and solution (reasonably), and readers could see if they’re a better detective than Batman. I’ll admit it wouldn’t be an easy book to write, but even if it comes out only every six months, that’s still twice as often as All-Star Batman and Robin.

2. Poetry
I’d love to see some comic book adaptations of classic poetry. Paul Pope does “To The Virgins To Make Much of Time.” Lea Hernandez tackles Shakespeare’s sonnets. Steve Bissette draws “The Rime of the Ancient Mariner.” Bryan Lee O’Malley takes on Emily Dickinson. And how about we get four comic artists of vastly different styles and they each have a go at “The Waste Land.”

3. John Carter of Mars
I know it’s been done before, but I’d like to see it done again, only better. Not necessarily a retelling of the books, but stories on Mars in their style, like Dark Horse’s Conan.

4. The Skrull-Durlan War
We’ve had the Kree-Skrull War and the Rann-Thanagar War. It’s time to take this concept to its logical conclusion: The Skrull-Durlan War. When everybody’s a shapeshifter, how will you know who’s fighting whom?

5. Dr. Mid-Nite
A JSA: Classified story arc that highlights the Doctor Mid-Nite legacy. I’d especially like to see it redeem the forgotten Dr. Midnight, Beth Chapel. Sure she had an ugly costume, but what member of Infinity Inc. didn’t?

6. 206
The follow-up to 52. Each week, a comic exploring a different bone of the human body. This week: the C1 Vertebrae, “Holding Up the World.” Next week: the Second Left Metacarpal, “The right hand doesn’t know what he’s doing!”

7. Penultimate X-Men
Featuring Penultimate Wolverine: “I’m the second best at what I do!”

8. Solomon Kane
Conan is good, but how about bringing back Robert E. Howard’s best character? The Marvel mini-series from 1985 was actually quite good, especially the first four issues that had Bret Blevins (#1-#3) and Mike Mignola (#4) art.

9. Ben Casey versus Dr Kildare
The grudge match to end all grudge matches. Two doctors enter, only one leaves.

10. Girlz
DC’s new imprint for minks.

Hank returns home from an evening of studying to find a mysterious woman in a wheel-chair waiting for him in his apartment. She explains that she is Barbara Gordon and she calmly informs Hank that she wants him to call Dawn because she needs to talk to both Hawk and Dove.

Once Dawn arrives, Barbara explains that she needs their help in taking down Velvet Tiger once and for all. She explains that Velvet Tiger was once one of Batgirl’s enemies, but since Batgirl has “retired,” Hawk and Dove will need to step in and apprehend Velvet Tiger. When asked how she learned their identities, Barbara plays coy at first, telling them that she got it from “an oracle.” Then she quickly explains that Oracle is a top secret government computer expert, but in the next panel she all but admits she is Oracle (”I hacked the Titan’s database”). Clearly this is before Oracle’s identity became the big secret it is now (and it is one of her first appearances outside of Suicide Squad).

Barbara tells the duo that Velvet Tiger is said to be Lani Gilbert, but she finds that hard to believe because records show that Lani is only ten years old. Barbara explains that the Tiger is trying to take out Washington D.C.’s mob bosses one by one so she can take over as top boss in the city. Barbara has been able to pinpoint who Velvet Tiger will attack next and she wants Hawk and Dove to intercept and capture her.

Across town, the Velvet Tiger and her bodyguard/lackey Sudden Death arrive at the hide out of one of the few remaining mob bosses. As the Tiger moves in for the kill, Hawk and Dove arrive. Hawk quickly subdues Sudden Death with the help of a conveniently thrown gas grenade. Dove’s battle with the Velvet Tiger is much more interesting. First, she fools the Tiger into thinking that Batgirl has returned. While Velvet Tiger is focusing on “Batgirl,” Dove tries to grab her and suddenly everything goes topsy-turvy. It turns out that Velvet Tiger has the ability to stop time and enter a special dimension that is “between the seconds.” Due to an unhappy childhood, she has spent years hiding in this dimension and the grown-up Velvet Tiger really is the ten-year-old Lani Gilbert. She now uses her powers for criminal gain and to evade capture. Since she is the only one who can survive in this dimension, her plan is to strand Dove here to slowly starve to death. Unsurprisingly, Dove is not too keen on this plan, and she deliberately strikes Lani’s already injured ribs so that the shock will cause her to bring them both back into normal time. As they suddenly appear in the hideout, Barbara shows up just in time to handcuff Lani to a pipe. She informs Lani that that while Dove may not be able to testify at a trial (because of that whole secret identity thing), Barbara will testify and make sure that the Velvet Tiger is put away for a long time.

As the issue ends, Dawn has a quiet chat with Barbara while Hank receives another message from his dead brother. This one asks him to steal a special sapphire from the Smithsonian Institute that he’ll need to bring Don back to life. Hank is unsure what action to take: he’ll do anything to bring Don back, but stealing would mean that he’d be “no better than a criminal.”

Notes:
The art by Greg Guler continues to be good. The writing by the Kesels is still good — particularly the quiet character moments — but overall the last issues of Hawk & Dove just don’t have the same zing as the earlier issues.
The Unofficial Oracle Chronology
Barbara Gordon makes a reference to the Titans Hunt storyline, the company-wide Titans crossover that was occurring at the time (and went for what, six or seven months?) This is the second reference to Titans Hunt in Hawk & Dove, but the actual crossover doesn’t occur until issue #28 and lasts for all of 2 panels before it is crushed (literally) by another company-wide crossover, War of the Gods. More about this when later.
While their children are off fighting the Velvet Tiger, Hank’s and Dawn’s parents are both attending a fancy soirée for Senator Tommy O’Neil. The parents chat for a bit and are clearly confused about who’s dating whom, but the main reason I mention this is that O’Neil will play a key role in the remaining 4 issues of the series.
I find the idea that Velvet Tiger has actually spent half her life hiding in her special between-seconds dimension and really should only be ten years old is kind of creepy, but handled well. It’s nice to see super-powers that actually have real world consequences.
All Previous Hawk and Dove Reviews

Tags: comics hawk dove batgirl oracle velvet tiger

Ray contains themes common in many other popular adventure manga: a hero with a unknown past, an evil conspiracy, a mysterious benefactor, beautiful girls, beautiful boys, and scenes of all-out action. It adds a strong dose of medicine to these ideas to freshen up the storyline. It’s not great art or realistic medicine, but it doesn’t pretend to be. It’s just an enjoyable escapist manga.

Volume 2 pretty much picks up where the first volume left off. Ray was raised in a hidden “organ farm” — destined to be the source of some rich aristocrat’s transplanted organs. As a young woman, her eyes were surgically removed and transplanted into someone else. Later, she was rescued from the farm — but she doesn’t know by whom — and given a set of new eyes: special eyes with x-ray vision. With these eyes and her incredible medical skills, she has become a renegade surgeon, fighting the shadowy organization that runs the organ farm and helping the downtrodden (or at least those downtrodden in need of surgery).

In this volume, Ray learns a little more about her past. She reconnects with several other children from the farm. Blue was introduced in the first volume, and now a young girl named Red Ribbon shows up as well. But all is not as it seems, and both of Ray’s friends hold potentially devastating secrets. In addition to new friends, a new villain also appears. He is an evil scientist who actively hunts Ray down rather than just waiting for her to show up and destroy his labs. He is everything a good villain should be: handsome, clever, and evil all the way through.

And then there’s the surgery. Every chapter features some manner of amazing surgery. The most dramatic are a hand that must be amputated to save a young boy from a bomb, and a bullet that is removed during delicate surgery atop a Ferris wheel.

Each chapter is about a different patient. Some of them tie into and advance the overall storyline, but many are unconnected chapters that just tell a simple story. The best chapters in the book are two of these independent stories. The Power…To Believe tells of Chieko, a teenager who for the past year has developed sudden lacerations, bruises, and fractures for no apparent reason. They seem to be getting more severe so Ray and her friend BJ (who is a dead ringer for that other famous manga renegade surgeon, Black Jack) track down the source of Chieko’s ailment. The ending is clever, but quite twisted. Blood is about a simple small town factory manager. He just wants to design the most efficient factory possible. He suffered a small injury at work that should have been minor, but it keeps bleeding and bleeding and bleeding. Will he be able to finish his new design before he dies, and can Ray do anything about it?

Ray is an enjoyable adventure manga with strong medical overtones. If either of these appeal to you, then Ray is a good choice. It’s over the top and more than a little unrealistic, but that’s what makes it such a good read.

And it once again showcases a great martial arts fight scene. No nurses this time, just a mysterious person in a bear costume.

My review of Ray, Volume 1

Tags: comics medicine manga ray surgeon

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In this week’s episode of House, the mystery is good, but the medical treatment is not. There are some good character moments, but this doesn’t stop the Tritter storyline from limping to a weak ending. Spoilers follow!

Derek, a firefighter, becomes short of breath and disoriented while at the scene of a fire. He tells his partner Amy that he is feeling chills. He is brought to the hospital and admitted to House’s service. Cameron notes that he has a fluctuating temperature as well as skin grafts over half his body from bad third-degree burns suffered on the job a year ago. She also discovers that he has had several episodes of disorientation in the past few weeks. Cameron reports that Derek’s tests for hepatitis C, HIV, TB (tuberculosis), Lyme disease are all negative, as is his drug screen. The EKG is said to show an “arrhythmia” (an abnormal rhythm) but House blows it off. Foreman suggests a hypothalamic tumor, while the other doctors are suspicious of a hospital acquired infection — one he picked up when he had his skin graft surgery and which has smoldered since then. They are concerned about MRSA (methacillin-resistant Staph. aureus), a particularly nasty germ.

Because of concern about MRSA, Derek is placed in isolation. He casually reveals to Cameron that everything looks blue. Foreman mentions heavy metal poisoning as a cause of this, particularly thallium. House suspects the patient has “male menopause” (low testosterone, elevated estrogen levels) brought about by burns he has suffered to his genitals. Viagra is known to cause blue color shifts, and House believes he is taking Viagra to make up for the effects of the low testosterone. The next time we see Derek, he is out of isolation (the MRSA tests came back negative) and he is receiving hormone therapy (apparently his levels were low). He suddenly starts screaming that the hormones are causing pain, then he lashes out and starts throttling Cameron. Foreman sedates him with some Lorazepam (brand name: Ativan).

The team tests, but Derek is not allergic to the hormones and they were not contaminated. Additionally, there is no evidence of a pulmonary embolism and his EKG is normal. Foreman, true to form, suspects a neurological cause, either a frontal lobe tumor or meningitis. However, a CT scan and lumbar puncture are normal. Other possible diagnoses mentioned include polyarteritis nodosa (a rare disease caused by inflammation of the arteries) and Legionnaire’s disease. Chase also believes it is unusual that Derek’s drug screen is negative as he must be taking some pain medication to treat the severe pain from his skin grafts.

The Young Guns are paged to Derek’s bedside where they discover that he has become suddenly short of breath and tachycardic (rapid heart rate). His oxygen saturation is 85%. Chase notices ST elevation on the EKG and realizes that Derek is having a heart attack. Elevated cardiac enzymes confirm this diagnosis (a heart damaged by a heart attack will release certain proteins in a predictable pattern over several days. By testing for these proteins, you can discover if a patient has had a heart attack.) The team eventually realizes that the common denominator in all of Derek’s attacks is his partner Amy. It is only when she is around that he has problems. They can find no inciting agents she carries, but Cameron recognizes that Derek is in love with Amy. He explains that she is engaged to his brother and that he can never have a relationship with her. Cameron explains to the rest of the team that Derek is literally dying of a broken heart.

The team starts Derek on beta-blockers and nitroglycerin (common medications for heart attack patients) but they don’t help. The team considers antidepressants, but discards the idea because House believes their side effects will make things worse (which is quite a stretch). Chase suggests propylthiouracil (a drug that is inhibits the thyroid gland), but House feels it would be bad for the heart as well (not to mention a bizarre and incorrect use of the drug). At the end, the team decides to use EST (electroshock therapy) to cause a permanent memory loss so Derek won’t remember Amy or his brother.

The therapy seems to be successful, but in a casual conversation with Amy, Cameron discovers that she was never engaged to Derek’s brother. It turns out that Derek had false memories (I would have first thought of House’s favorite mantra –”patients lie” — rather than jump to the diagnosis of false memories). A brain MRI (now they get an MRI) shows decreased blood flow to one part of the brain. A close look at the blood flow in the spine shows a spinal meningioma (a tumor of the membrane that covers the spinal cord) that is pressing against the blood vessels supplying blood to the brain. When this tumor is removed, Derek will be good to go (well, except for that permanent memory loss).

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Medically, the two big problems this episode were the EKGs and the ECT.
In the beginning, House ignores an abnormal EKG. You never ignore an abnormal EKG — that’s just asking for trouble, and they would likely have made the diagnosis much sooner (but then the show would be too short). Then later in the episode, Derek had a normal EKG. If he truly had suffered multiple heart attacks, there’s no way he would have had a normal EKG.

The biggest problem was the EST. First, there’s no way EST would ever be used without a psychiatrist’s evaluation and consent, and no psychiatrist would jump straight to EST without attempting other therapies first. A thorough testing, evaluation, and history would reveal the false memories. EST is still used occasionally for depression, schizophrenia, and mania — but the patient is suffering from none of these. EST can certainly cause memory problems, and does cause temporary memory loss in most patients, but it is not a predictable effect and ECT is not used to purposefully block out memories.

For nitpicking, I will point out that the bacterial cultures came back surprisingly fast once again, and that Cameron needs to brush up on her isolation skills. She wasn’t dressed correctly for either contact isolation or drawing blood.

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On the non-medical side, I liked the scenes with House and Cuddy and House and Wilson — especially the ones with Cuddy; she showed some real teeth. I thought his interactions with Foreman and Chase were good, but wasn’t as impressed with the scenes with Cameron.

Legally, it seemed all wrong. I am certainly not a lawyer, but the show seemed to be confusing grand juries and actual trials. The judge said she was going to determine if there was enough evidence to try House, which suggests a grand jury (or something like that), but House pleaded “Not Guilty” before that. How can he plead if he hasn’t been brought to trial on charges yet?

And the resolution of the whole Tritter storyline? Let’s just say that it ended with a whimper and too much deus ex machina for my taste.

I did like that House had the last laugh after all.

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The medical mystery was good, so I give it a B+ and the ultimate solution was well-thought out and earns another B+. The actual medical treatment was bad, especially the EST aspect, and drags down the overall medical score to a D+. The character interaction/soap opera was good and earns an A-. Overall, I give the Tritter arc a C-.

The previous House review
A list of all prior House reviews

Tags: television medicine house mrsa electroshock therapy meningioma

Superman #675 “Camelot Falls”
Kurt Busiek, writer
Carlos Pacheco, penciler

It’s the future in the DC universe. Not far in the future: just seven years, but sometime in these seven years a massive disaster has occurred. Tidal waves, volcanoes, floods, and resulting “nuclear winter” have killed millions if not billions.
Among the survivors are a band of resistance fighters that includes Lois Lane, Jimmy Olsen, and Lex Luthor. As the book begins, Jimmy is returning from a foray into what’s left of Metropolis.

Let’s take a minute to look at the medications Jimmy collected, and how useful they may or may not be in a post-apocalyptic world:

Amoxicillin — A broad spectrum antibiotic. This definitely would be useful. With fewer people around and fewer doctors over-prescribing medications, bacterial drug resistance should wane over the years and Amoxicillin would probably be more useful in this future world than it is now. (Background reading: MedlinePlus information on amoxicillin)

Prednisone – A corticosteroid. Used most commonly in the treatment of inflammatory disorders (asthma, certain types of arthritis, lupus, etc.). Also used for immune suppression, both long term (transplants) and short term (poison ivy dermatitis). I can see how this would be useful to have on hand. (Background reading: MedlinePlus information on prednisone)

Macrodantin (generic name: Nitrofurantoin) — Another antibiotic. This one is more specific than Amoxicillin and is used almost exclusively for the treatment of urinary tract infections. Another useful medication. (Background reading: MedlinePlus information on nitrofurantoin)

Dilantin (generic name: Phenytoin) – Used to prevent seizures. Like many of the older seizure medications, Dilantin has a specific blood concentration where it is most effective and requires fairly regular monitoring of these levels. In an ordinary post-apocalyptic scenario (if there is such a thing), you would think that blood levels would be impossible to monitor, but with Lex Luthor involved here, he’s probably worked something out. This would be a useful drug to have on hand if there are patients with a seizure disorder; a way to check blood levels would be nice. (Background reading: MedlinePlus information on phenytoin)

Coumadin (generic name: Coumadin) – A blood thinner. Used in patients where blood clots are present or may develop. Like Dilantin, Coumadin needs regular blood tests. It requires testing more regularly than Dilantin because too many things can affect the level of blood thinner including other medication and diet (and a regular diet is probably pretty rare in a post-apocalyptic situation). Levels of Coumadin that are too high greatly increase the risk of bleeding from regular activities such as brushing the teeth or going to the bathroom.
Even at correct levels, Coumadin is not always a safe drug and the risk of serious bleeding is always present. There is a definite risk/benefit ratio we watch closely when prescribing Coumadin and I suspect that in a post-apocalyptic world this would be skewed far to the risk side, particularly if there is no way of checking the level of blood thinning. (Background reading: MedlinePlus information on warfarin)

Tags: comics medicine superman kurt busiek amoxicillin prednisone macrodantin dilantin coumadin

By far the creepiest cover on this year’s Advent Calendar. In fact, I’m positive it’s the creepiest cover of any of the Advent Calendars I’ve done. It’s just wrong on so many levels.

Anyway, this is the variant cover of the Fantastic Four #4 from the 1996 series (you remember, the barely-lasted-a-year-”Heroes ReturnReborn”-version) with uncredited cover art that has to be by Whilce Portacio.

The entire 2006 Comic Book Calendar Advent Calendar (so far).
One year ago, the cover was Jingle Belle #4.
Two years ago, the featured cover was Street Fighter #4 (variant cover).
The 2005 Comic Book Cover Advent Calendar The 2004 Comic Book Cover Advent Calendar
David Carter always has another good comic book advent calendar over at Yet Another Comics Blog*
Two newcomers to the comic book advent calendar world this year: ShadZ and Brendan McKillip

*Please join me in supporting Dave’s annual CBLDF fundraiser.
Tags: comics advent calendar christmas fantastic four

As Hawk & Dove neared the end of its run, there still remained several outstanding issues. Unfortunately, there were also an increasing number of issues that were painfully mediocre. This is one of those comics.

It starts out promising. Dove and Captain Arsala are on a date, just like in issue #13. She ditches him in the middle of the meal, only to reappear a few minutes later as Dawn. It’s part of her cunning plan to make Arsala think that Dove is flighty and that Dawn is a better prospect for dating. Ren and Hank are hiding in the restaurant helping Dawn with her plan.

There is a brief interlude featuring the Velvet Tiger and her new bodyguard, Sudden Death, putting the squeeze on a Chinese mob boss. The scene returns to the restaurant as Captain Arsala is leaving. He promises to call Dawn and then drops a cryptic comment about missing Teen Titans¹.

Hank, Dawn, and Ren start walking home when they stumble upon an attempt on the Velvet Tiger’s life². They change to Hawk and Dove and swoop in to help, unaware that the Tiger is actually a vicious criminal. The team sent to dispatch her is the Cyber-Brats, easily one of the lamest villain teams of the nineties³. There is Database, a young kid who has a keyboard on his forearm and a wheel instead of his left leg (here he comes: step, roll, step, roll, step, roll). He doesn’t seem to have any powers other than shouting out random technobabble. Next is Cursor who controls a 4-inch flying sphere. She can hang onto it and “fly” or use it to hit people. She doesn’t last long in the fight. Modem can materialize in and out of electronic equipment and is also down for the count quickly. Mainframe is a bruiser (or “tank” if you prefer MMO-speak) who can increase in size and power, like Giantman. He’s the only one who actually puts up a fight.

Then the fifth member of the Cyber-Brats appears: their leader, named Hakker, who can possess any one of the other ‘Brats and manifest through them as a giant computerized Grim Reaper. It turns out that he is actually the older brother of the Velvet Tiger — and he is here to “cut out her evil side.” In the end, the Cyber-Brats are captured and the Velvet Tiger escapes, but not before revelaing her evil sadistic side to Dove.

The excitement over, everyone returns home and Hank finds another message waiting for him from his deceased brother asking for his help.

All Previous Hawk and Dove Reviews

Tags: comics hawk dove velvet tiger

After visiting the seriously hurt Rodger in the hospital, Hank walks home, blaming himself for Roger’s injuries. He stumbles across a drug deal and wastes no time in trying to break it up. He can’t change into Hawk because it would be out in the open and everyone would see. He fights strictly as Hank and does well at first, but then one of the drug dealers pulls a knife. Luckily, Dawn was concerned about Hank’s state of mind and had been following him. She changes into Dove and quickly takes care of the drug dealers. She then delivers a stern –- and mostly tongue-in-cheek — warning to Hank about letting those with powers handle crimes.

Watching the melee across the street is former beach bum Sudden Death (remember him from issue #5?). He wants a rematch with Hawk and figures that if Dove is around, Hawk can’t be too far behind. He strolls into the fracas, pushing Hank aside to confront Dove. Unfortunately, Sudden Death shoved Hank straight into a tree, knocking him out. Dove realizes that she’ll have to buy time for Hank to recover. She dodges Sudden Death the best she can, then pulls that hoary old comic book cliché “overload the villain.” Sudden Death explodes, ripping a great hole in the ground. He is stunned, but Dove and Hank fall down the hole into a Metro tunnel. Seeing a train barreling down upon them, Dove manages to wake up Hank just in time for him to turn into Hawk and stop the train.

Hawk jumps up to the surface and pummels Sudden Death again and again. As Sudden Death nears critical mass, he throws him at a tree in the distance. The tree explodes, but Sudden Death mysteriously disappears.

All in all, this is a fairly light comic with well done guest art from Steve Erwin. This issue is mostly a set-up issue, as the storylines and villains of the final six issues of the series are introduced. Velvet Tiger appears, first as someone who’s killing mob bosses, then as the rescuer and potential employer of Sudden Death. (For those of you who don’t remember the Velvet Tiger, she was one of Batgirl’s foes from the 1980s.) The last two panels of the issue set up a cliffhanger that really drives the remainder of the series: Hank receives a message on his new answering machine from Don, his dead brother.

All Previous Hawk and Dove Reviews

Tags: comics hawk dove velvet tiger

A xenograft is the transplantation of a tissue or organ from an animal to a human. In the early 1960s attempt were made to transplant chimpanzee kidneys into humans. It didn’t work particularly well with the longest recipient living for 9 months. There have also been attempts to transplant primate hearts into human, but again, the results were not particularly encouraging.

A more successful example of xenografting has been the transplantation of pig and cow heart valves into humans who have defective valves. There are also ongoing studies looking at transplanting animal neural tissues into patients with Parkinson’s disease.

In comic books, xenografting has been much more successful:

• In Jumbo Comics #99, Sheena fights Panther, a criminal who has had his own eye replaced with the eyes of a leopard.
• Gorilla-Man (Arthur Nagan) was a surgeon who experimented with xenografts of gorillas and humans. Through circumstances that aren’t entirely clear, he ended up with his head transplanted onto the body of a gorilla.
• The definitive example must be the Ultra-Humanite, who transplanted his brain into the body of giant white ape.

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Please Note: Xenografting is not to be confused with Xenagrafting, which the transplantation of tissues or organs from the Warrior Princess onto normal people.

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Other Comic Book Diagnoses:
Frozen Solid
Brains! Brains!
Hypertrichosis

Tags: comics medicine xenograft sheena gorilla-man ultra-humanite xena

A much darker issue of Hawk & Dove than usual, but given that it is dealing with Apokolips — at least in part — that should come as no surprise. The story by the Kesels is up to their usual standards, and I think Karl Kesel is one of the best of the modern comic book creators at handling the legacy of Kirby’s Fourth World. Steve Erwin handles the art this issue and does an excellent job, particularly when you consider that he has to deal with some of those bizarre Apokoliptan outfits.

It’s a girl’s night out. Dawn, Ren, and Donna are skating at the Capitol Skating Rink. Actually, Dawn and Donna are skating, Ren is floundering. There is a loud Boom and two armored women appear and start wreaking havoc at the skating rink and the surrounding parts of Washington D.C..

Across town, it’s also a guy’s night out and Hank, Kyle, and Rodger are at an inner city Boy’s Club. Here, at last, we learn the secret of the Black Russian. Honestly, it’s not much of a secret: Rodger dresses as the Black Russian, a fake super villain, to teach children how to deal with child molesters. Hank and Kyle are along to watch. The act is interrupted by reports of a fire down the street and Hank and the gang run off to investigate.

The villains in both cases are the same. A squad of Female Furies has come to Earth from Apokolips. Two teams of two Furies each are competing to score the most points by claiming prizes from their dead victims. The ultimate prize is the mask of a super hero; whichever team obtains one will win the competition – the other team will be punished by Granny Goodness.

The Female Furies seen here aren’t the main Furies, but instead four junior Furies. There’s Malice Vundabaar and her giant invisible cat, Chessure. Speed Queen is super strong strong and wears roller skates (think an Apokolips version of Dazzler). Bloody Mary is a vampire with telekinetic powers. Finally, there’s Gilotina who has hands which are able to cut through anything. This issue marks the first appearance of these newer Furies, except for Gilotina who appeared briefly in Mister Miracle #8. They have all since shown up a few times including Superboy #24-25 (also written by Karl Kesel) and, if memory serves, at least one episode of Justice League Unlimited.

Dove fights Gilotina and Speed Queen. She tricks Speed Queen into rolling full speed into the Potomac, and then confronts Gilotina. Speed Queen climbs out of the river and grabs Dove. She is able to escape and Speed Queen plows full speed into propane truck. The resulting explosion slows down the Fury, but doesn’t stop her. She is ready to attack Dove again when a Boom Tube appears and Speed Queen and Gilotina are whisked back to Apokolips.

Meanwhile, Hawk battles Malice, Chessure, and Bloody Mary. He is clever enough to use Bloody Mary’s telekinesis against her, but Chessure is strong enough to inflict a great deal of damage on the near invulnerable Hawk. When Hawk is ultimately captured, Rodger tries to distract them so Hawk can escape, but he is in turn targeted by the Furies who see his Black Russian costume and think he is another super-hero. They attack Rodger, grab his mask and then Boom Tube back to Apokolips, the victors in their deadly little competition.

As the issue ends, the Furies have returned to Apokolips but left behind scores of dead and injured, as well as a mortally wounded Rodger.

All Previous Hawk and Dove Reviews

Tags: comics hawk dove apokolips female furies

This is the third in the series of Canadian public service comics that were later republished in America. Remember how in the first issue Peter Parker came to Canada to track down Electro’s drug supplier? And remember in the second issue how Spider-Man stopped the Chameleon from stealing a young girl’s science fair project? You don’t remember? That’s okay because none of it matters to the plot in this issue at all. All you need to know is that Peter Parker is in Toronto to cover the Toronto Blue Jays/New York Yankees game.

The action starts as young Phil Danton is riding his bike to the stadium. He’s excited because that night he and the other members of his bicycle team (the “Right Riders”) are going to demonstrate bicycle safety before the game and then get to watch the game free. He’s also hoping he can get some autographs from the ballplayer. Phil’s running late so he cuts through an alley. Unfortunately, a drunk driver also picks that moment to use the alley as a shortcut and hits Phil head-on before fleeing the scene.

Luckily, Phil’s American cousin happens to be in town — a cousin named Danny Ketch. For those of you who remember the ’90s, you’ll recall that Danny Ketch was the alter ego of the second Ghost Rider, a ubiquitous character who appeared in almost as many comics as Wolverine. Danny gets Phil to the hospital and then hunts down the drunk driver as Ghost Rider. The driver escapes and manages to convince Spider-Man that it was Ghost Rider who hit Phil, not him.

Spidey hunts down Ghost Rider and because this is a team-up comic book, they fight. Meanwhile, the drunk driver hires some goons to kill Phil because he thinks Phil is Ghost Rider. Spidey and Ghost Rider manage to patch up their differences (the issue being mainly that Spider-Man believed the word of a two-bit thug over someone he’d worked alongside before) and make it back to the hospital in time to rescue Phil. The goons are caught, the drunk driver confesses, and Phil gets an autographed baseball and visit from BJ Birdy, the Blue Jay’s mascot.

Compared to the strong anti-drug and anti-cigarette stance of the previous issues, this comic is really not much of a PSA comic. It reminds us that drunk driving is a bad thing, and it teaches a little about bicycle safety. Speaking of bicycle safety, I think I’ll let Ghost Rider have the last word:

This is the only PSA comic I know of that resorts to a direct threat.

Part One: The Amazing Spider-Man — Skating on Thin Ice!
Part Two: The Amazing Spider-Man — Double Trouble!

Tags: comics psa spider-man canada ghost rider

So your little mutants, metas, and heroes are having trouble learning their ABCs and are on the verge of flunking out of Preschool?

Don’t worry. Here at Polite Dissent we have developed The X-Men Alphabet Primer to help with just such a problem!

A is for Angel, who soars with the birds.
B is for Beast, who uses very big words.
C is for Cypher, shot in a fight.
D is for Dust, who wears her burqa too tight.
E is for Empath, not a giver; a taker.
F is for Forge also known as the Maker.
G is for Gambit, whose accent perplexes.
H is for Havok and his many complexes.
I is for Iceman who loves absolute zero.
J is for Juggernaut who’s playing at hero.
K is for Karma, the niece of a crime lord.
L is for Lila, once queen of the rock chord.
M is for Magneto, who is rather intense.
N is for Nightcrawler who has a tail and can fence.
O is for Onslaught, a sorry occasion.
P is for Psylocke, once English, now Asian.
Q is for Quentin, one of Xavier’s ex-pupils.
R is for Roulette, a Hellion without scruples.
S is for Strong Guy who is strong…and a guy.
T is for Thunderbird, the first one to die.
U is for Unus, who is strongly protected.
V is for Vulcan, a brother neglected.
W is for Wolfsbane, who’s been let off her leash.
X is for X-23, just another pastiche.
Y is for Yukio, one of Claremont’s inventions.
Z is for Zaladane, with evil intentions.

I’m going to take an evening to look back at the beginning of Grant Morrison’s memorable run on Animal Man.

In Animal Man #1-4, writer Grant Morrison tackles anthrax. Animal Man has been hired by STAR Labs to track down a stolen ape that was used for experiments and the man who stole it. It turns out that the ape in question was being used for experiments with anthrax.

Anthrax is a disease caused by Bacillus anthracis, a rod shaped bacteria. When exposed to harsh conditions, the bacteria forms a spore that can survive for decades. When this spore enters an animal or human body, it rapidly comes to life and begins reproducing and pumping out potent toxins. Thankfully, anthrax is a rare disease is humans, though it has become notorious for its potential as a biological warfare agent.

Doctor Myers: Are you familiar with the symptoms of anthrax, Animal Man? They’re very unpleasant. It usually begins with a red swelling at the site where the bacillus gains entry into the body — This is followed by listlessness, headaches, ulcers, internal bleeding, convulsions, septicemia — and ultimately of course — death.

The doctor seems to be confusing the different types of anthrax infections. Cutaneous Anthrax is the most common type. It occurs when anthrax bacilli or spores get into a cut in the skin. Within twenty four hours,o a raised bump develops on the skin that looks like an insect bite. Over the next 48 hours, this bump develops into a large painless ulcer with a black center. Untreated, cutaneous anthrax can sometimes spread to the rest of the body through the bloodstream. It is fatal 20% of the time unless antibiotics are used, in which case it is almost always treatable.
Inhalation Anthrax is the most dangerous and the most lethal. It is caused by inhalation of anthrax spores. Early symptoms are similar to a bad cold. Later symptoms include severe respiratory distress, shock, and death. If caught early (before the symptoms appear), it can be treated with antibiotics. If treatment is delayed, inhalational anthrax is almost always fatal.
Gastrointestinal Anthrax is caused by eating meat contaminated with anthrax. It causes nausea, vomiting, fever, severe abdominal pain, inflammation of the gastrointestinal tract, bloody vomiting, and severe diarrhea. Untreated, it is fatal about half the time.

Doctor Myers: It’s highly contagious and any other living creatures coming into contact with the man or the ape are in very serious danger. Given the right condtions, the entire state of California could be unihabitable within weeks.

More confusion from Dr. Myers: anthrax is not spread from person to person. Infection occurs from direct exposure, inhalation, or ingestion of the anthrax spore, not from contact with an infected person.

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Towards the end of the story, Animal Man confronts B’wana Beast, who is dying of anthrax. Animal Man uses B’wana Beast’s own powers to fuse several different types of infection fighting cells together.

Animal Man: And I combined his body’s own polymorphs and macrophages, creating super-powerful defense cells which began to attack and destroy the invading anthrax virus [sic].

Polymorphs (also known as polymorphonuclear cells or PMNs) are a type of white blood cells. There are three varieties of PMN, the most common of which is the neutrophil , which also happens to be the most common white blood cell in the body. The neutrophil is an infection fighting cell and travels quickly to the site of an infection. Once there, it ingests and then destroys the invading germs — and itself in the process. It doesn’t have a long life span, just a few hours. Think of the neutrophil as a kind of white blood cell shock troop: fast and brutally efficient, but with little finesse.

The macrophage is a large white blood cell. Like the neutrophil, it also ingests attacking germs. Unlike the neutrophil, it is a long lived cell and can attack multiple bacteria for an extended period of time. The macrophage also serves as an “antigen presenting cell” and plays a key role in the body’s production of antibodies against the invading germs.

While the neutrophil and macrophage are both types of white blood cells that ingest attacking germs they both carry out vastly different roles. The neutrophil has evolved to die quickly in a blaze of glory, while the macrophage is a long lived cell that helps the body improve its own defenses. This is why I’m not convinced that merging them into a super cell would accomplish anything worthwhile…but I can’t say for sure that it wouldn’t work, so I’ll give Morrison the benefit of the doubt (but I’ll still remain highly skeptical).

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There is certainly some confusion in the story about the time course and symptoms of an anthrax infection. There are also mistakes regarding how contagious anthrax actually is. Bear in mind that the the story is concerned with a specially engineered form of anthrax designed for biological warfare and this “modified anthrax” can be used as an excuse for the discrepancies.

However, calling anthrax a virus (which Morrison does repeatedly throughout the story). That can’t be explained away so easily.

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Previous Examinations of Comic Book Biological Warfare:
“Red Zone” (Avengers #65-70) and “Tinker, Tailor, Soldier, Spy” (Mystique #7-10)
Batman/Nightwing: Bloodborne

Tags: comics medicine canada anthrax b’wans beast grant morrison

In my years of reading comics, I’ve read my share of bad comics, and sometimes really bad comics.

Rarely, however, have I found a comic so bad that I find myself needing to burn it until nothing remains but ashes, then bury those ashes and salt the earth afterwards. That is a Godwaful Comic. These are the comics that companies should be ashamed of publishing. They should apologize to their readers and pay us money for having suffered through them. These are the comics that all but guarantee that I will never purchase any title involving those responsible ever again.

I used to stumble upon these books maybe once every two or three years. Sadly (and painfully), I have encountered two of these comics recently. Both have been from DC, and both have been part of the “One Year Later” storylines.

Battle for Bludhaven #5 has, without a doubt, the worst art that I have ever had the misfortune of experiencing in an (allegedly) professionally published comic. At what point does the editor have the responsibilty to say, “Stop! This sucks! Do it over!” It’s not like this is Civil War — it’s not like anyone was waiting with bated breath for this comic. If if had come out a month or two late, I doubt anyone would have noticed, and I sure whould have appreciated it. Of course, the story would have still been terrible, but at least the art wouldn’t require me to claw my eyes out anymore.

Nightwing #122. I’m not sure I can put the sheer horribleness of this comic into words. Just let me highight (or low-light) a few key moments.

• The repeated mentions of “Cleveland” as if it has some deep meaning. This might have been effective had it been brought up from the beginnig of the storyline, but to abruptly and awkwardly inject it into the “climactic” fight scene? It was unbelievably awkward and halted the momentum every time it occurred.
• The deus ex machina of having Jason Todd suddenly turn into a bizarre monster that swallows and then regurgitates his opponent. Where the hell did that come from? And why? Just having a random meteorite fall from the heavens and crush the bad guy would have been more logical, believable, and been less insulting to the reader.
• Jason Todd saying “so long good-bye” by telegraph. After nearly two years of Jason Todd being a focus of the Bat-Books, he just suddenly decides to leave and announces it, not in person, but by a technology that was abandoned two years ago amid multiple news reports discussing the demise of the telegraph.
• Ending the book on a stupid pun/joke. This isn’t Scooby Doo — though that clearly was the comic I should have bought.

Tags: comics godwaful comics battle for bludhaven nightwing

Finally had time to sit down and read Astonishing X-Men #16. A quick read, but a good one. Particularly nice fight scene between Kitty and Emma…which is as it should be since we’ve been waiting since issue #1 for it (or Uncanny X-Men #151-152, if you really want to know the truth).

As for the revelation of the identity of the secret fifth member of the Hellfire Club. Who would’ve guessed that it was really Ben Casey…but it makes a certain amount of sense.

Seriously, I suspect in one way or another it will come down to Mastermind. He was a key player in the era Whedon seems to draw his inspiration from, not to mention he’s been involved with the Hellfire Club before. Mastermind. You heard it here first.

Tags: comics astonishing x-men ben casey mastermind

I mentioned last post how poor the art was on Ben Casey #4. On first reading the comic, I noticed how much the one character looked like Sean Connery. Then I noticed how I kept seeing the same heads over and over again. Take a look a Ben Casey, particularly his head in the next few panels — it’s the identical head, just tilted slightly from panel to panel…

Here’s Ben looking pensive.	Here’s Ben flirting.
Here’s Ben taking charge.	Here’s Ben whining.

What’s that you say? You want to see some action shots? Sure thing!

Ben in a knife fight.

And Ben dancing.

Tags: comics medicine ben casey flashback week

For the last subject of Flashback Week 2006, I thought I’d take a look at Ben Casey #4. It features another strongly moralistic story of the Ben Casey standard: A street thug moves into a new neighborhood and begins terrorizing the resident. He sends one young boy to the hospital with a crushed skull. The boy’s brother goes looking for revenge and ends up getting shot by the thug. In a scene almost identical to the much maligned one from Detective Comics #814, the police use the wounded patient as bait to lure the thug to the hospital. In the end it is Dr. Casey who sudues and captures the criminal in an operating room.

The reason I’m mentioning this book is the art. For starters, take a look at the thug. Look familiar? Tell me that’s not Sean Connery (with a few extra warts). And that one fight scene sure looks like Sean is taking on Elvis.

The art is clearly just phoned in on this comic. The few times the artist has to show a face that is not obviously light-boxed or cut-and-pasted (literally, this was 1963), it is horribly drawn and carries no resemblance to the appearance of the same character just the panel before.

Tags: comics medicine ben casey sean connery elvis flashback week

For those of you too young to remember (including me), Ben Casey was television show that ran on ABC from 1961 to 1966. It starred Vince Edwards as Dr. Ben Casey, a neurosergery resident at the hospital 59 West. Dell published ten issues of a Ben Casey comic book from 1962 through 1965. Today’s topic is Ben Casey #3 from December, 1962.

Dr. Ben Casey and his co-worker Dr. Maggie Graham take their boss Dr. Zorba out to dinner for his birthday to the Periscope, an expensive seafood restaurant. Also dining at the Periscope that night is the famous actor Brent Calhoon. An obnoxious drunk spills some food on Calhoon’s wife and then picks a fight with Calhoon. It’s a vicious fight and both combatants end up down for the count. The drunk has been knocked unconscious and Calhoon has multiple facial lacerations and fractures.

Ben Casey examines the drunk and realizes that he’s in bad shape with a probable subdural hematoma. The ambulance arrives and both patients are rushed to the hospital. Casey operates on the drunk, drilling several burr holes to drain the hematomas. It’s a tough operation and the patient survives — at first, but dies from his injuries about an hour later.

Dr. Casey then goes to evaluate Calhoon. As he surmised at the restaurant, Calhoon has suffered a couple of jaw fractures, something easy for good oral surgeon to fix. When Casey informs him that the other patient died, Calhoon becomes hysterical. It takes an injection of a sedative before he finally calms down.

Outside Calhoon’s room, Casey encounters the press corps who want to know about Calhoon and the other patient. Casey starts to explain the situation, but a reporter accuses him of covering up the fact that Calhoon is guilty of murdering the other fighter. That doesn’t sit well with Casey who is ready to start a fight of his own, but luckily at just that moment he is called to Dr. Zorba’s office.

Inside the office, Dr. Casey finds the District Attorney waiting for him. The DA is ready to charge Calhoon with murder, but wants Dr. Casey’s opinion on the case as he operated on the dead man. Casey informs the DA that the operation revealed that the patient had suffered multiple head traumas over the years that had weakened his blood vessels. Thus while Calhoon may have struck the fatal blow, the previous injuries had contributed to the death as well. Furthermore, Casey points out that he recognized the patient as a local professional boxer. That means that his fists are considered lethal weapons and according to the law, Calhoon was merely acting in self defense. After his talk with Dr. Casey, the DA drops all charges against Calhoon.

Meanwhile, Calhoon has become paralyzed and is unable to walk. He is convinced that he has suffered some brain damage in the fight and he needs immediate brain surgery. He knows this because he once played a doctor on TV. Casey has a different opinion. He recognizes that Calhoon is suffering from hysterical paralysis from guilt over the death of the drunk. Casey recommends a psychiatrist, but Calhoon refuses, demanding surgery.

Eventually Dr. Casey relents and Calhoon is wheeled off to surgery. Once the patient is anesthetized and the surgery started, Casey hands the scalpel off to another doctor. A few hours later, Calhoon is wheeled back to his room for recovery. The next day, miraculously, Calhoon is no longer paralyzed and can walk again. Talking privately to Calhoon’s wife, Casey tells her that they never performed any brain surgery on her husband, they just repaired his jaw fractures. They lied to him about the brain surgery so he would think he could walk again. Casey tells Calhoon’s wife to keep this a secret, and then he, Maggie, and Dr. Zorba head off to the hospital cafeteria to finish Dr. Zorba’s birthday dinner.

This was an entertaining story with a couple of clever plot twists. The “hands are lethal weapons” was a nice way out for Calhoon, though I wonder if that’s true legally or just an urban legend. Calhoon’s hysterical paralysis added another dimension to the story though the sham operation was more than a little unethical and is likely to backfire when (and if) Calhoon realizes the truth. While not quite unethical (at least according to the 1960s), you’ll notice Dr. Casey was freely sharing a great deal more of his patients’ medical information than he should have been

In addition to the Ben Casey main story, the comic contains a four page Dr. Dan Dazzler backup story as well as a one page text story about Dr. Lester Dingwall and a pet monkey. The inside covers concern the history of medical inventions and the founding of the county’s first tissue bank. The back cover piece is about Florence Nightingale.

Tags: comics medicine ben casey flashback week

Continuing the medical annotation of Naoki Urasawa’s Monster. This time, I’ll take a look at the first half of the recently released Volume 3, chapters one through four.

Nothing medical happens in the first chapter, so the annotation begins with:

Chapter Two
Tenma is taken to treat a terrorist injured in a gunfight with the police. He realizes that the man was shot through his axillary artery and is bleeding to death.

The axillary artery is an important artery. It starts off as the subclavian artery, coming off the aorta. As it dives under the shoulder it is known as the axillary artery. It then becomes the brachial artery (the main artery of the arm) as it leaves the shoulder. It’s a large enough artery that an injury to it could lead to death from blood loss, and fairly quickly.

Tenma apparently* stops the arterial bleeding with direct pressure, a valid approach, but he succeeds conveniently quickly. Next he announces that he needs to close the injury to the skin which he proceeds to due with a handy stapler. This makes little sense. I have no problem with the use of the stapler — it’s nearby and it works — I’m just not clear on why he closed the wound in the first place. Tenma knows the patient will require a surgical repair of the artery, so the doctors will just have to open the wound up again. The closed skin may provide a little pressure which will help keep the artery from bleeding, but a simple pressure dressing would do the job much better.

After closing the wound, Tenma places the injured arm in a sling, picks the man up fairly roughly (especially considering he is nearly dead already) and moves him outside for the police to find.

Read more…

This is a comic that was produced by the United States Forest Service and the Ad Council during the 1960s and early ’70s. I remember owning it when I was a preschooler. It was always one of my favorites. It tells the true story (more or less) of Smokey Bear, who went on to become Smokey The Bear and the forest fire prevention mascot of the U.S. Forest Service.

As the comic starts, a forest fire rips through Lincoln National Forest in New Mexico. Most of the forest animals flee, but many perish in the flames. One lone animal survives the fire: a badly burned bear cub stuck in a tree. The firefighters rescued him and he was bandaged up and his burns treated. The rangers called him Smokey and he became the mascot used to remind the public that “Only You Can Prevent Forest Fires.”

Smokey lived out his days at the National Zoo in Washington D.C. I remember seeing him as a youngster in the ’70s, so I’m sure he has long since passed on. I just remember that I could care less about the pandas and the other exotic animals, it was Smokey that my sister and I desperately wanted to see on our visit to the zoo.

• Thanks to the Minnesota Department Department of National Resources, you can download your very own copy of this comic. About 3/5 of the way down the page, under the “Smokey comic book audio CD” heading is a link to a pdf file of the comic (though the last four pages seem to be the same in my copy).
• In addition to this freebie comic, Smokey had Gold Key comic book series that ran for 13 issues from 1970 to 1973. Not to be outdone, Woodsy Owl (”Give a Hoot, Don’t Pollute”) had a ten issue series, also from Gold Key, from 1973-1976.
• Wikipedia tells a slightly different origin of Smokey the Bear. I’m sure theirs is correct as it is more politically expedient, but I prefer the comic book version.
• Why should you, as a comic reader, care about forest fires? From the comic book:
  Smokey tells them how he hates forest fires!
  How they destroy his animal friends…
  How they burned up timber that could have been used to make homes — perhaps a new home for you…
  How they waste wood that could have gone into furniture…
  

Tags: comics psa smokey the bear forest fires

“Dallan and Sepsis Preserve Us!”

Those of you who read the Marvel Comics series Micronauts during the ’80s no doubt recognize that sentence, while those of you with less comics knowledge but more medical background are understandably puzzled. It was a common oath muttered (or screamed) by the denizens of Homeworld whenever danger threatened.

A little background: A thousand years ago, King Dallan Rann and Queen Sepsis Rann were the rulers of Homeworld, the lead “planet” in the Microverse. They sent their only son Arcturus Rann out to the far reached of the universe on a thousand-year quest for knowledge¹. Shortly after he left, Dallan and Sepsis were killed by their son’s tutor, Baron Karza², who went on the conquer Homeworld and the rest of the Microverse and set himself up as dictator. Upon returning from his voyage and discovering what had happened in the Micorverse while he had been gone, Arcturus Rann took the name Space Glider and joined the Resistance trying to drive Karza from power. With the other core members of the Resistance (Marionette, Bug, Acroyear, Microtron and Biotron), Rann formed the Micronauts³.

Personally, I think it’s a clever bit of storytelling to have the modern denizens of the Microverse revere Dallan and Sepsis Rann as saints or demi-gods. It ties together the past and present of the Microverse (but for Space Glider, it’s got to be a bit creepy having your girlfriend pray to your dead parents).

Dallan is a good name. According to Wikipedia, in the Christian context it means “blind,” named after the blind Irish poet Saint Dallan Forgaill. It’s also an Arabic word meaning “lost” which can be used in several contexts including a loss of the true religion. It’s not an uncommon name for boys.

Sepsis, on the other hand, is an unfortunate choice for a name. Sepsis is the medical term for an overwhelming infection of the entire body, though the term is also used to refer to the body’s response to this overwhelming infection. Regardless, sepsis is frequently fatal and always represents a tough battle to survive. Not the best name for a beautiful Queen, though I doubt writer Bill Mantlo was aware of the actual meaning of Sepsis when he chose the name⁴. Still, it’s hard not to chuckle whenever I see a character praying to “Sepsis.”

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NOTES:
¹Not the really best plan to insure the continuance of your dynasty.
²If I were undisputed ruler of the Microverse, I would have chosen something better than Baron. King, or Emporer maybe.
³Though I notice the team was now called the Microns when they appeared in Peter David’s Captain Marvel. I suspect it has to due with the rights to name Micronauts.
⁴Though Mantlo also named another beautiful female character Slug, so maybe he used the term on purpose.

Previous fond memories of the Micronauts:Micronauts #26-28 (The Micronauts and S.H.I.E.L.D. fight Karza)