Polite Dissent

Not the best episode of Fringe. The storyline was pretty cliche (the sheriff involved, really?) and the science was wrong, wrong, wrong.

The Plot: A state trooper picks up a young boy running away from home. A few minutes later, he looks over at his passenger and discovers that the boy has suddenly become horribly deformed. The trooper arrives at the station and he and two coworkers photograph the child and enter him into their database. They all mention that they’ve heard rumors of deformities such as this, but never actually seen one. Suddenly, a car pulls up and three adults, all as deformed as the child, enter the station and kill all the troopers, reclaiming the boy.

The Fringe team is called in because of the picture of the deformed boy. Looking through other files at the station, the team finds thirty years worth of similar reports, though no actual evidence, all centered on the nearby town of Edina. Deciding that it’s their next logical stop, the team heads over to Edina where they meet the local sheriff. He tells them he’s also heard stories of deformed people nearby, but never seen one. He also identified the sound the team has heard since entering the town as the “Edina Hum” – which he blames on turbines at a nearby military base. Strangely, the hum causes Walter to start singing nonsense words to Bizet’s Carmen.

As the team heads out of town back to their hotel, they are run off the road by a pick up truck. Dunham was knocked out by the crash but Peter stayed conscious. Walter is blissfully asleep in the back seat. The pickup that ran them off the road comes back and a deformed men gets out and starts shooting at the wrecked car. Peter gets off a couple of shots, and actually thinks he hits the shooter, before he gets back in his truck and drives away. Other federal agents arrive and inform the team that they’ve found an abandoned truck that matches their description. Peter spots a blood trail leading into the woods, and they find a dead man –- but he’s not deformed at all. The corpse is sent to Walter’s lab for autopsy.

Agent Broyles tells the team that the nearby Army base was once home to classified experiments known as “Project Elephant” back in the ‘70s. Meanwhile, in Walter’s lab, when the body bag is opened, the corpse has become deformed once again. Walter continues to sing Carmen and Astrid realizes that the song is really a mnemonic for “Harkness,” which Walter recognizes as the name of the campus’s law library. Furthermore, he remembers that he did work on “Project Elephant” –- which dealt with camouflage — and hid some papers in the library, which he and Astrid successfully recover.

Peter and Dunham are going through the county and federal records on the town of Edina and realize that several key files are missing. The census date shows the town population has only changed by deaths and a few births — no one has moved in or out of town in the past thirty years. The town sheriff calls to tell Dunham that he has located the owner of the truck and wants Peter and Dunham to join him at the subject’s house. They agree, unaware that the sheriff is setting a trap for them.

Walter tells Astrid that the people of Edina are all hopelessly deformed because they lived too close to the military experiment. However, in order to help the people of Edina, one of the scientists built a giant transmitter that sends out powerful EM waves which fool the eyes into thinking what they see looks normal. Thus, as long as the residents stay within Edina and range of the transmitters, their deformities are hidden. When they leave town, their deformities can be seen again. Walter and Astrid find the transmitter and shut it off, proving his theory, as all the deformities are suddenly clear. Across town, the sheriff is not particularly good at his ambush and loses a few men, but he ultimately gets the drop on Peter and Dunham. Luckily, one of the town’s residents – sick of all the death of innocents – steps up and shoots the sheriff, saving the team. In the end, the transmitter is left on for the residents and it is decided that no one outside of the Fringe team and the residents will learn the truth about Edina.

1. The Eyes Have It
The eye does not act as a transmitter, sending through whatever the eye sees to the brain as if it were a fiber-optic cable. Instead, the receptors in the retina at the back of the eye are triggered by certain specific wavelengths of light, and when they’re triggered, a nerve impulse is sent to the visual areas of the brain. No extraneous information is transmitted. If a wavelength is not visible, it’s not visible, end of story.
So the EM wave is a low enough frequency to be heard as a deep hum, but still manages to affect the eye?

2. Are You Still Rose or Am I Hitting on Susan?
For the sake of argument, let’s say that the EM camouflage does work. How would it remain constant from person, to person, time to time? I see Rose as beautiful brunette instead of a Troma look alike. Does the person next to me see the same Rose as I do? If I leave town and then come back, does she still look the same to me?

3. A Window To the Soul (Kinda)
A Johari window is a cognitive tool that compares how we see ourselves with how others see us. It looks into four areas of personality: Arena (known to others and known to self), Façade (known to self but unknown to others), Blind Spot (known to others but not known to self), and “Unknown.”

4. God, that hand! The window! The window!
This is another episode this season (the third, I think) that had some definite Lovecraftian overtones, in this case “The Shadow Over Innsmouth”, about an isolated town with a deformed populace and a hidden secret.

5. Not What I Expect To See In a Corpse
Frankly, I’d expect histolysis (tissue decay) to be present in any corpse, not just shapechangers.

6. A Generation Unexplained
A germline mutation would be inheritable, but it wouldn’t have a tremendous (really any visible) effect on those originally exposed to the mutagen. So Teddy would be visibly deformed, but if Walter is right, Rose shouldn’t be.

Painfully bad science this week, the Fringe Doomsday Clock advance to 11: 56 (ironically, the real Doomsday Clock was moved back a minute this week)

Tags: television fringe mutation camouflage science

This episode seemed like it was trying to be a cross between House and Brotherhood. A novel approach, but the medicine suffered for it.

In a dark garage, a drug deal is going down between two groups of mobsters. When one of them gets antsy and starts flashing a gun around, another of the mobsters jumps him. In the struggle, the gun goes off and one of the combatants slumps to the ground. It turns out he wasn’t shot by the gun — he just collapsed.

A little while later, House is sewing up the Mickey the mobster’s forehead laceration. Being quick on the uptake, House realizes what line of work his patient is in. He suggests Mickey stay in the hospital for a work-up, but he declines. As Mickey and his partner leave the room, House slams his cane into the table and the sudden loud noise causes Mickey to collapse. He gets admitted to the hospital after all.

House presents the patient to the team as a “32 year-old man who recently developed loud-noise induced vertigo.” There is no medical history as Mickey does not want to share anything. Foreman suggests the cause must be in the ear or brain, and since a brain CT scan was negative, it must be in the ear. He suggests an acoustic neuroma (a tumor of the eighth cranial nerve, the nerve involved with hearing). An ABR is ordered to test for the neuroma (An ABR — or Auditory Brainstem Response — is a hearing test that looks specifically at the nerve component of hearing. If you’ve seen a hearing test done on a newborn in the hospital, you’ve seen one of these) . House announces that the diagnosis might be lidocaine or benzocaine toxicity, as both chemicals are commonly used to cut cocaine.

While the team runs the ABR, House talks to Mickey’s partner Eddie who swears that Mickey never touches the cocaine. The ABR is normal, but Mickey has a seizure during the test, which Foreman announces must be due to his elevated blood pressure. Mickey is started on a vasodilator (a blood pressure medication that works by dilating — opening wider — his blood vessels) and his blood pressure improves. The differential now consists of sick sinus syndrome (the heart’s “pacemaker” isn’t working right), carotid stenosis (narrowing of the carotid arteries), or toxin exposure. A carotid ultrasound (to look for the narrowing) is normal. Figuring the cause must be toxin exposure, the team discharges Mickey with the plan of trailing him back to his hideout, but he manages to ditch them.

Mickey is brought back to the hospital several hours later delirious with a high temperature. He is given antipyretics (fever reducing medicine, usually acetaminophen [Tylenol]) and “soft steroids” (basically, a specially engineered steroid with less side effects. Sounds nice, but doesn’t really apply in this case. Technobabble) The differential diagnosis now consists of an environmental exposure (but House figures Mickey wasn’t out of the hospital long enough to be re-exposed) or an infection. A lumbar puncture is performed and shows no sign of infection. Chase notices that despite it being a poorly performed lumbar puncture (and therefore qutie painful) , Mickey’s heart rate never budged when it should have shot up with the pain. Chase suspects Mickey has autonomic dysfunction, but House doesn’t think the symptoms match. He confronts Mickey who admits that he’s been taking a beta-blocker (a blood pressure medication that slows the heart rate) for his nerves.

Given the symptoms of vertigo and fever, and Mickey’s high stress occupation, the team decides he must have “excess adrenalin” and probably has a pheochromocytoma (a tumor that pumps out high levels of adrenalin and similar compounds). An MRI of the adrenal glands is negative, ruling this out. Once again, the team decides the cause must be environmental. Meanwhile, House had bugged Mickey’s room so he could learn more information about his background, but the bug never worked well. Eventually, he realizes that something is interfering with it and suspects that it’s another bug in the room. Sure enough, he finds a second bug and deduces that Mickey is an undercover cop. He reluctantly admits that House is right. Suddenly, Mickey experiences severe abdominal pain. Later, Chase reveals that he suffered a GI infarction (the blood supply to the bowel was cut off, causing some of the bowel to die. Like a heart attack, only of the bowel) of the superior mesenteric artery, and a foot of his bowel had to be removed.

Reviewing Mickey’s symptoms of vertigo, fever, and clotting (the high blood pressure is discounted because it is felt to be a rebound high pressure from skipping his medications), the team decides yet again that it must be an environmental exposure. Thirteen leans on Eddie who agrees to take her to the hideout. It turns out to be a dry cleaners, and she takes multiple samples — but they all turn out to be negative. Just as the team is stumped, Mickey starts coughing up blood. A VQ scan (ventilation-perfusion scan) of the lungs shows a pulmonary aneurysm (a bulge in the blood vessels in the lung), which Chase surgically repairs, but the next morning, three more have appeared. House and team decide this must be a fungal infection and start Mickey on antifungal medication, but it doesn’t seem to be working. Totally out of the blue, House deduces that Mickey has Hughes-Stovin Syndrome, an autoimmune disease. Unfortunately, by the time it’s reached this stage it is fatal and according to House, Mickey has but a few days — or hours — to live. House’s prediction is true, and Mickey dies in the arms of his wife a little while later.

Lots of errors this week, and several big ones, too. As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:

Hughes-Stovin Syndrome is not a good fit. True, once the aneurysms start rupturing the patients often die (but even then there are treatments that have been tried — sometimes successfully — and since when has House’s team just given up like that?)
The aneurysms do not appear overnight, but appear over time.
Hughes-Stovin Syndrome is associated with venous thrombosis — but the patient had an arterial thrombosis — a different animal all together.
There is a good chance the steroids given earlier would have helped the Hughes-Stovin Syndrome.

10-20% of pheochromocytomas occur occur outside the adrenal glands, so a negative adrenal MRI would not rule them out (especially in House’s world, where the uncommon is common).

The superior mesenteric artery is a major blood vessel and supplies much of the bowel with blood. A blockage in it would cause the patient to lose more than just a foot of bowel.

Despite having a diagnosis of “vertigo”, the patient didn’t really show much in the way of vertigo. Sure, vertigo can cause drop attacks (from extreme dizziness and loss of balance), but the patient never complained of any of those symptoms. The drop attacks looked more like those cataleptic goats.

It’s quite a jump in logic to decide that the high blood pressure caused the seizure. There’s so many other possible causes. For instance, Lidocaine toxicity — House’s suggested diagnosis — is well known for causing seizures.

Did I really see Foreman jam something in the mouth of seizing patient? In 2010? He’s a neurologist, he should know better.

Expect to see results from antifungal medication in a few hours? Nonsense. That would be fast for regular antibiotics, let alone antifungals which are slower (as I tell patients in the office, fungus grows slowly, so it dies slowly).

If Mickey took enough beta-blockers to not respond to pain, then he would have an extremely low heart rate, definitely below sixty and probably even lower.

Beta-blockers do not cause a noticeable rebound high blood pressure. Certainly not one high enough to cause a seizure.

A VQ scan is a logical approach to diagnosing coughing up blood (looking for a pulmonary embolus), but isn’t good at showing aneurysms. The image Chase showed was way too clear for a VQ scan (here’s what one really looks like; very fuzzy) — it was probably a CT.

Is Foreman really expecting inhaled Albuterol to fix what is clearly a systemic problem?

It was strange the way the writers were being very coy with medications this episode: “vasodilator,” “antipyretic,” and “soft steroid” rather than actually naming the drugs, like they always (or almost always) have before.

It was hard, but you’ll notice I made it through the entire review without resorting to a “Can’t Hardly Wait” pun.

The scene in the clinic (at least I assume it was the clinic) where House deduces the source of Mickey’s injury was well done, and very Holmesian.

The medical mystery was okay, but I question if the patient really had what they said he had — I give it a C. The final solution was a big stretch, and in shooting for pathos, they shortchanged the team. It gets a D. Overall, the medicine was more often than not, painful to watch: another D. The soap opera was quite good though (with this week’s theme seeming to be “deception”) and earns a solid A.

The House Challenge scores have been posted here.

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

This episode of House started well but collapsed under the weight of its ridiculous medicine in a surprisingly short period of time. The soap opera was well done and enjoyable, though

Jordan, a sixteen year-old girl, and her best friend bluff their way into a band’s post-concert party. The next morning when they are regaling their other friends with the details of the night (including alcohol, marijuana, and skinny dipping), her friends notice that Jordan’s ankles are very swollen. Seconds later, her fingers become swollen too, and then she collapses on the floor.

Admitted to Princeton-Plainsboro, House is convinced that Jordan has rhabdomyolysis (muscle damage, often caused by a crush injury. He thinks she injured herself climbing the fence to the pool to go skinny dipping). The rest of the team suggests that she may have a deep vein thrombosis (a blood clot), anaphylaxis (a life-threatening allergic reaction), or even a heart condition, but House maintains that Jordan must have rhabdomyolysis. Tests reveal that Jordan’s muscle enzymes are elevated (a sign of rhabdomyolysis), but the scans show no sign of the muscle injury House was suspecting.

House now looks over the labs and notices that Jordan has a low potassium. He has her air drum (like air guitar, only drumming), but she can only drum for a minute or two before her arms are too tired to lift. House states that this muscle weakness is a sign of low potassium, and since she would have had a low potassium the previous night as well, there was no way she had the muscle strength to climb the pool fence. In other words, he accused her of lying about what happened. Later, Jordan and her friend admit to Cameron and Chase that in reality, they only wanted to go to the party because their favorite comic book/movie writer Jeffrey Keener would be there. They then proceeded to stalk him for the next few hours (going where he went, eating what he ate, etc), before finally going to bed.

The differential now consists of an unknown food allergy, plus Cameron thinks that Jordan may be bulimic. They run a scan to look for a Mallory-Weiss tear (a rip in the esophagus seen in people who vomit frequently, like bulimics), and when they don’t find one, decide that she isn’t bulimic. As they finish the test, Jordan’s blood pressure drops suddenly and then she flatlines. Foreman starts CPR (good for him). Chase announces that Jordan has cardiac tamponade (the pericardial sac — the membrane around the heart — has become filled with so much fluid the heart can no longer beat correctly) and he plunges a needle into her chest to draw off the blood around the heart and relieve the problem. Somehow, this brief moment of tamponade has severely damaged (“constricted”) her heart, necessitating use of antiarrhythmic medications (drugs to prevent abnormal heart rhythms). Since Jordan’s blood pressure drop was sudden, House decides that this means she has an acute problem, not a chronic one. Therefore, the most likely diagnoses are toxin exposure or infection, but the team still needs to figure out which toxin or which infection.

Things continue to worsen for Jordan. She tells the team about stopping by Bruce Springsteen’s house and playing guitar with him . She is lying and does not even realize that she is doing it. Additionally, Foreman notices blood dripping from her ear and announces to her friend that bleeding in her brain is affecting her thalamus and this is causing her to lie. (When did he get an MRI to determine this? And why would bleeding in the thalamus — in the center of the brain — leak out the ear? Did she somehow rupture her eardrum too?)

The team reviews the videotapes from the hotel that night and discover that Jordan sneaked out of her room briefly in the middle of the night. They see her a few minutes later carrying Keener’s journal. He apparently left it in the restaurant and she went back to get it. They figure that she must have stopped by his room to return the journal and maybe something happened to her there. Chase and Cameron confront Keener in his hotel room — he shuts the door in their face. Cameron now suspects that Jordan was slipped some roofies (a slang term for Rohypnol, an alleged common date rape drug) and wants to start her on Flumazenil (a medication which reverses the effects of Rohypnol and similar drugs). When they return to the hospital, they find Foreman frantically working on Jordan. He tells them that she has been bleeding behind her kidneys and has required multiple units of blood. Cameron thinks it looks like a “toxic reaction.”

Cameron realizes that they must figure out what really happened to Jordan that night. Her plan is to give Jordan Amobarbital — i.e.truth serum — so they can discover the truth. Jordan is given the drug, and under questioning, admits that she went to Keener’s room where he invited her in and gave her Ecstasy — only it didn’t have the same effect on her that Ecstasy usually does — this pill made her sleepy. She then begins telling the team how Keener started to touch her. As her father gets more and more upset, Foreman points out that the scans indicate “increased periorbital blood flow” meaning that everything she just said is a lie.

Most of the action now shifts upstate, where Cuddy, House, and Wilson are at a medical conference. At one point, the team talks to Wilson and tells him that since Keener travels with his dog, Jordan may have come down with Rickettsia (not the name of an infection per se, but a genus of tick-borne bacteria that cause such diseases as typhus and rocky mountain spotted fever). A short time later, in the middle of an argument with Wilson, House has his Eureka! moment and calls the team. He announces that Jordan has Vibrio vulnificus, a not uncommon bacterial contaminant of the raw oysters Jordan ate. For most people, the bacteria present no problem (or mild nausea and vomiting), but Jordan also has hemochromatosis. According to House, this made her more susceptible to the contaminated oysters. The Vibrio infection explains her initial symptoms. Then the team, thinking she had bulimia, started her on iron-containing vitamins, which worsened the symptoms of the hemochromatosis (by causing iron overload), resulting in liver damage and bleeding. They gave her transfusions, which again worsened her symptoms (more iron overload). However, with the right diagnosis and some Cetazidime (an antibiotic for the Vibrio) and chelation (for the excess iron), she should be as good as new.

Tonight’s episode was rife with errors, far worse than usual. I did my best, but I’m sure some obvious one slipped by. As usual, major complaints are in red, minor in blue, nit-picking in green:

The truth serum idea was simply ridiculous. Amobarbital does not work like Cameron explained, and it is far from foolproof — for example, it’s easy to create false memories (and the questioner Cameron clearly had a preconceived belief of what happened to Jordan).
Telling truth from lies is not nearly as black and white and Foreman makes it seem. You can’t look at an fMRI report and definitively state “she was lying the entire time” like he did. But it sure would make police interrogations and court a lot easier if it worked as easily as Foreman implies.
Anyway, where is the fMRI? Jordan was in a bed in the center of the room. There was no MRI equipment in sight. Nothing to read the “increased blood flow” he mentions.

Cardiac tamponade or not, you don’t just plunge a needle and syringe blindly into the chest — you’re likely to do more harm than good. Yes, you can perform a needle pericardiocentesis, but it’s more involved than “plunge and pray.”
Why would 20 seconds of tamponade cause a permanent conduction problem in the heart?

A day or two of iron supplementation is not enough to cause that severe liver damage in a patient with hemochromatosis. And apparently it kicked in really fast, because it bled into her pericardial sac mere minutes after suggesting the diagnosis of bulimia, let alone giving her vitamins with iron.

Jordan’s symptoms do not match Vibrio at all. For starters, she has no gastrointestinal symptoms from what is essentially food poisoning.

When did Foreman get an MRI to determine that Jordan had “bleeding into her thalamus?” And why would bleeding in the thalamus — in the center of the brain — leak out the ear? Did she suffer head trauma which disrupted her ear canal and also ruptured her eardrum?)

Rhabdomyolysis can have other causes other that a direct muscle injury, so not seeing a specific injury on the scan means little (for example, many marathon runners end up with some rhabdomyolysis by the end of their race, but it’s not a single muscle, but most of them, so a scan would show nothing)

Not everyone with bulimia develops Mallory-Weiss tears, in fact, most don’t. So not seeing a tear does not mean she is not bulimic.

Edema is swelling of soft tissue. Effusion is the swelling of a joint. They are not the same thing and the terms should not be used interchangeably. A halfway decent physical exam, especially on someone as skinny as Jordan, should easily tell them apart.

Assuming Jordan did receive Rohypnol, the flumazenil, a benzodiazepine antidote, is a reasonable choice. But by the time Cameron would have given the drug to her, the rohypnol would have been long gone from her system.

Rickettsia is a genus of bacteria, not a specific disease.

Rhabdomyolysis is very hard on the kidney. I would think twice, and then a third time, before giving such a person IV contrast (also very hard on the kidneys).

I thought the medical mystery itself, and the confusion of the always changing history, was intriguing this week and deserves a B+. It goes downhill from there. The final solution did not fit the mystery at all — either solution — and earns a D-. The medicine overall was a complete mess, with scattershot diagnoses, ideas abandoned for sloppy reasons, and missing equipment. It earns a solid dismal F. The soap opera was a bright spot — especially all the scenes at the conference — and earns an A.

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

The House Challenge scores are now up to date here.

Amazing Spider-Man #600

When evaluating the pupillary response in a patient, have them take off their sunglasses first.

Invincible Iron Man #14

We already know that Norman Osborn is no good at anatomy, but it turns out he is clueless at computer science as well. Here, when he is trying to convince the Russians to allow him in their county to look for fugitives Tony Stark and Pepper Potts, he refers to “picobytes of…data.”

There is no such thing as picobyte — it is impossible. A byte is made up of 8 bits*, and a bit is as small as you can subdivide a byte. A “picobyte” then, would refer to one trillionth (10^-12) of a byte, which is orders of magnitude smaller than a byte can be divided.

I assume Osborn meant to say “petabyte” (a quadrillion bytes) — or maybe he meant Pikabyte, the loneliest of the Pokemon.

*There have been computer systems in which a byte is more or less than 8 bits, but 8 bits is standard now, and it was never more than 36 bits-per-byte.

Last week, I discussed a vaccination that prevented you from becoming a zombie. Tonight’s subject is the opposite: a vaccination that turn you into a zombie (actually, it turns you into a mindless super-strong drone, but close enough). This comes from the Pyroman story “The Saboteurs of Steel” in America’s Best Comics #4 (1943).

Evil gangster Ornitz sneaks into a nearby Army base and slips his mind control serum into the paratyphoid vaccine. The next day, the soldiers are vaccinated…

…and they all become the invulnerable super-strong mindless slaves of Ornitz who uses them to take over the Army base.

Can Pyroman stop Ornitz and his army of Army men? Of course he can, this is his story after all. To understand how he does it, it helps to understand the story as a whole:

A couple of medical notes to end the post:

Paratyphoid fever is similar to the more famous typhoid fever, though it is usually milder. It is caused by a bacteria from the Salmonella family, which is found in contaminated water. It is rare in the United States, Canada, and Europe but fairly common in developing nations. There is a vaccine available, but it not used very often as it is only partially effective.

As the vaccination is labeled “serum,” I suspect the soldiers are getting an immune globulin injection to ward off paratyphoid, and not actual paratyphoid vaccine. In immune globulin injections, the patient receive an injection of antibodies against the disease. These antibodies will circulate for several months, protecting the patient, before eventually breaking down. The patient does not gain any permanent immunity from the injection. This is known as passive immunity, as opposed to active immunity, which occurs when patients are exposed to the germ in question and develop their own antibodies. Active immunity can occur by natural exposure, or by vaccination. All the vaccines routinely given in the United States induce active immunity.

Because you demanded it, I’m going to end the summer’s public service ads with two weeks of PSAs featuring Binky’s younger brother Allergy, in all his huge bow-tied glory. And not just any Allergy PSAs, but two ads concerning Allergy and his pet dog (though, ironically, allergies to dogs is never mentioned).

This week, Binky and Allergy reveal that they are completely clueless about pets, which makes you wonder why their parents let them have one in the first place. They probably should have started them out with fish, a hamster, or a turtle. For example, based on the sixth panel, I’m wondering if they ever fed the dog before they had that chat with their neighbor. No wonder Sport doesn’t like them!

Click on the image for the full ad

This PSA is found in DC comics from October 1953. Like nearly all DC PSAs, it was written by Jack Schiff. Art was handled by Win Mortimer, who did most of the Binky PSAs. This copy was scanned in from Adventure Comics #193.

More PSAs

Tags: comics psa binky allergy pets dog jack schiff win mortimer

Looked at as the product of its times, Superboy’s method is not an entirely unreasonable attempt at resuscitation. It may seem obvious that Superboy should have gone straight to mouth-to-mouth resuscitation instead of building his contraption¹, but we have to remember that the current mouth-to-mouth² style of artificial respiration hadn’t been invented when this comic was published³. During Superboy’s era, two of the most commonly taught techniques of resuscitation — the Schafer method and the Holger-Nielsen method — had the patient positioned on their stomach the same way Lois is.

Still, there’s no way Superboy’s plan is going to work, and it comes down to A. Remember the ABCs of resuscitation are Airway, Breathing, and Circulation. Superboy’s skipped ahead to the B (breathing), but hasn’t done anything to make sure Lois’s airway is open. Until he takes care of that, he won’t be able to get any air into, or out of, Lois’s lungs.

The human airway has a tendency to close in on itself. To prevent this from happening during resuscitation, special breathing tubes are placed down the throat (intubation), positive airway pressure is used (bag mask ventilation), or special positioning is used. Superboy has done none of this for Lois. The way she is slumped forward, her airway is definitely closed and there’s no way Superboy will be able to force air into her lungs, no matter how much pressure he uses⁴.

Sorry Lois, Superboy should have skipped his super-resuscitation and just used the normal technique — you would have had a better chance of survival.

Notes:
1. That’s really more of a pressure chamber than an iron lung
2. or Mouth-to-mask-to-mouth
3. Adventure Comics #261: 1959. Mouth-to-Mouth rescue breathing 1972.
4. He’ll bust her eardrums long before he gets any air moving in her lungs.

After last week’s brief discussion of CPR¹, I felt it would be a good time to look at CPR as practiced in a variety of comic books. First up, DV8 #3 (1996), by Warren Ellis² and Michael Lopez.

Evo and Frostbite stumble across the body of a young woman who has suffered a drug overdose. They proceed to CPR.

Evo is shown using a sit-on-top-of-the-patient style, as opposed to the correct off-to-the-side style. I don’t know why he’s chosen this stance, but it’s going to make it more difficult to move the patient and I suspect it will restrict some of the blood flow to the legs. It would also be a bad idea during a code blue because those femoral veins and arteries he’s blocking are good places get vascular access (plus it’s mighty hard to balance like that on a hospital gurney).

I have absolutely no idea what Frostbite is doing with the patient’s arms, unless he’s trying to use an older and for-good-reason forgotten resuscitation techniques. Whatever he’s doing seems to make her sleeves appear and disappear though.

Even though rescue breathing is no longer recommended for standard CPR, it was when this book was published, so it’s unusual that Evo and Frostbite are ignoring it — especially since they remarked earlier that she is suffering from respiratory arrest.

Successful resuscitation? Yes (though they then leave the scene, leaving the patient alone to suffer the other potentially fatal effects of her drug overdose. After all, the drug is still in her system.)

NOTES:
1. What I’ve read suggests CPR as we know it was developed in the late ’50s and early ’60s, but not taught to the public until the early ’70s. I’d like to think the Avengers would be ahead of the curve and trained in CPR by Iron Man #18. In 2008, it was switched to a chest compression only style.

2. Yes, Ellis is British, and they may have CPR taught slightly differently there, but DV8 takes place in the US, so I’m going to hold him accountable for the standard American Heart Association CPR.

And that look apparently of consists fake facial hair…

ad from Iron Man #16 (August 1969)

Tags: comics ad beard moustache iron man

Or you could just use CPR.

It’s the first thing you should try to get a “stilled heart” to beat again (and this is at least a decade before AEDs were available).

So, CPR. Right now.

Seriously, if you’re going to whisk Tony Stark away to the Avengers Mansion to play guinea pig for the Ultra-Rejuvenator , at least give him CPR in the meantime to keep the blood circulating — especially to the brain.

Scene from Iron Man #18 (by Archie Goodwin and George Tuska)

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

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

Action Comics #871 “New Krypton, part 2: Beyond Doomsday”
Geoff Johns, writer
Pete Woods, penciler

Geoff Johns is usually one of the better writers at incorporating science — or at least decent pseudo-science — into his stories. But in this scene from a recent Action Comics I have to call his bluff:

Superman: You know of Doomsday, Zor?

Zor-El: We know of him.

He was scientifically created on ancient Krypton through the the violent and vile process of Forced-Evolution.

A child was sent into the wild, killed and then cloned from the remains and the process was repeated…

…until that child had evolved to withstand the harsh environment and bloodthirsty creatures of our primordial world.

Here are three good reasons that this “forced-evolution” is utter nonsense and could not have worked:

1. Evolution requires change, particularly change at the genetic level. In the process Zor is describing, there is no change. Cloned individuals have identical genetic codes. Since each generation is a clone of the previous generation, their genetics are identical and the scientists are essentially sending the same kid out again and again and again. This is not evolution; it’s stagnation.

2. Zor seems to imply that the child abandoned in wilderness develops some new skills or abilities to help him survive and this is what leads to evolution. The child may certainly have acquired what he needed to survive the wilds (but not, apparently, survive the scientists), but it’s all a moot point: acquired abilities cannot be inherited.

3. Finally, species evolve, not individuals.

If the Kryptonian’s grasp of geology is as good as their understanding of biology, it’s no wonder nobody but Jor-El noticed the planet was going to explode.

A rather unexciting episode of Fringe overall, despite several clever plot concepts. Definitely a “sum of the whole is less than the parts” week.

The Plot: A young woman is desperately trying to get to a hospital when she suddenly catches fire and explodes. Agent Dunham and her team are called in to investigate. Through dental records, they are able to identify her as Susan Pratt, a 29 year-old toll booth attendant. They search her apartment and find a large check made out by a mysterious lawyer, a lawyer whose office seems hurriedly deserted. Walter initially suspects spontaneous human combustion, and then deduces that Susan was a pyrokinetic (think Firestarter) who could not control her own powers.

Meanwhile, Agent Dunham is having recurrent hallucinations. Walter tells her that she is experiencing déjà vu, which he explains are visions of an alternate reality. The next time Dunham has one of the hallucinations, she investigates and discovers that in this reality, Susan had a twin sister Nancy. Sure enough, in our reality there is a twin sister too, and Olivia’s team rushes to Nancy’s apartment, but she has been kidnapped. Luckily, Peter has invented a machine that can pull sounds from an apartment window which was melted during the kidnapping. Uncovering the sound of a phone dialing, Olivia is able to trace a call made to Sanford Harris’ phone (if you can’t remember, Sanford Harris is the new a**hole boss at the FBI who took over earlier in the season). She and Charlie track Harris to a warehouse where he and the lawyer have locked up Nancy and are experimenting on her. In the final confrontation, Nancy is rescued and Harris burned alive by her pyrokinesis.

The episode ends with a variety of short scenes: Olivia confronts Walter about the experiments he and Walter Bell performed on her and other children, Nina visits Broyle to discuss the reappearance of the Observer, Walter discovers the missing original ZFT manifesto just as the Observer walks in and tells him it is time to go, and Nina is shot by masked men in her apartment building.

1. Walter’s Reality, Quite Different From My Reality
A myth is an unverified fact? I’m sure Zeus would be happy to know he’s factual, merely unverified.

2. Again and Again
That is an interesting explanation for déjà vu. Just saying.
Would Robert Frost approve?

3. Too Close a Look
There are so many things wrong with Peter’s electron microscope/Geiger counter/mp3 player. Here are just a few:
Electron microscope samples have to be specially prepared.
At electron microscope level, there would be so many natural grooves and bumps in the surface of the glass that it would have tremendous background noise. Even an LP or CD at that level of detail would have so many imperfections it would be hard to hear the actual sound.
A flash fried window captured that much sound?
Peter was somehow able to reproduce the sound perfectly down to the exact voices and tones of a dialing phone?

4. Irony
I had to laugh when Walter told Olivia she was a good investigator — she’s anything but. For instance, she missed the entire closet full of gray clothes and the check from a mysterious lawyer that all tie into the emotion spewing guy from episode 17.

5. Y Kant Olivia Read?
Olivia is a cornflake gal. Is that anything like a Cornflake Girl?

A plainly mediocre episode. Not bad enough to advance the clock, but not good enough to gain some time. (With just one episode left, it is extremely unlikely the Doomsday Clock will run out…this year at least. Fringe has been renewed, so I’ll continue the clock next year.)

A mystery with potential, an interesting patient (in an annoying sort of way), and good soap opera all marred by very sloppy medicine (but at least they got the defibrillation right this time).

Doug is an environmental activist who starts the episode chained to a giant bulldozer. After being forced to leave, he stumbles around and discovers that he is unable to walk or even stand up. He sees a variety of specialists, but no one can cure him, so he is transferred to Princeton Plainsboro and admitted to House’s team.

Cameron tells the team that the “tox screen” is negative, and that there are no neurological, muscular, or cardiovascular abnormalities. House has Cameron perform a vestibular caloric test (irrigating cold water in the ear canal and monitoring any resulting nystagmus — eye twitching) to test his inner ear — the test is normal. Foreman suggests that Doug may have carotid atherosclerosis (hardening and narrowing of the carotid artery, leaving Doug at risk for stroke) worsened by stress. House orders a Holter monitor and a carotid doppler, both of which are normal. While performing the procedure, Cameron discovers that Doug has a serious case of the hiccups, and has had them on and off for a week. She realizes that his hiccups are somehow tied in to his condition. She suggests that he may have organophosphate poisoning from spending time protesting at commercial agricultural warehouses (organophosphates are commonly found in commercial insecticides). Taub counters that multiple sclerosis is a more likely diagnosis. House agrees and orders a lumbar puncture to test for the disease.

Cameron is having difficulty performing the spinal tap on Doug because he keeps moving when he hiccups. She gives him some chlorpromazine (better known as Thorazine, a potent antipsychotic which can be used to treat intractable hiccups). Then Foreman notices some swelling in his neck. At first, Cameron thinks it is torticollis (a severe muscle spasm) caused by the chlorpromazine, but House points out the neck is not just stiff but swollen. It also crunches when he touches it, a sign of crepitus, or air in the subcutaneous tissue. In this case, it comes from an “air leak between the lungs.” Sarcoidosis is suggested, but so is scleroderma, and House chooses to go with the latter, starting Doug on intravenous steroids.

Doug is lying in bed, wheezing (and this wheezing is never really mentioned or even addressed), when he develops a sudden excruciating pain in his left leg. The team decides it is likely osteomyelitis (infection of the bone) after deciding it is not a tumor, aneurysm, or metabolic bone disease. He is started on intravenous antibiotics and x-rays of the left leg are obtained. Surprise, surprise — the x-ray shows a fracture of his left femur. Cameron suggests it may be due to osteogenesis imperfecta (an inherited bone disease), but House is convinced it’s cancer. He wants to start Doug on chemotherapy. Meanwhile, Chase is surgically repairing the broken leg (because he’s an orthopedic surgeon this week), and Foreman asks him to obtain a bone biopsy at the same time. The biopsy is clear, showing no cancer. Unfortunately, Doug has bleeding problems after the surgery, with bleeding from the leg wound and purpura (a skin discoloration that is commonly seen in platelet disorders, vasculitis, and coagulation disorders) showing up on the other leg. Foreman orders 2 units of FFP (Fresh Frozen Plasma).

House is still convinced Doug has cancer and wants to proceed with total body irradiation. Instead Taub suggest that they give Doug Insulin-like Growth Factor, which should make the cancer grow larger, and thus they’ll be able to find exactly where it is. It should really come as no surprise that House agrees with this dangerous and unethical plan. About this time, Doug goes into pulseless ventricular tachycardia and needs several shocks to resuscitate him (and defibrillation is the right idea in this situation). An echocardiogram is normal, as is the troponin level (a blood test that is elevated after a heart attack). House and the team are stumped, stymied, and stuck. They have no idea what is happening to Doug. House decides to implant a defibrillator while they try and deduce what is going on. Then he his has his weekly Eureka! moment talking to Wilson. Despite being fervently anti-commercial-florist, Doug broke down once and bought his wife some roses after missing their anniversary. He caught sporotrichosis (a fungal infection) from those roses, and that’s what’s caused his problems.

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

There are hundreds, if not thousands, of different kinds of cancer. Different types of cancer require different types of chemotherapy. What works for one cancer may not work for other cancers. There is no generic “chemotherapy” that treats every cancer — you need to know what type of cancer you are treating.

Similarly, total body irradiation only works on certain cancers — the blood and lymphatic cancers, primarily.

How exactly did the sporotrichosis make Doug unable to walk and start this entire situation? Are they suggesting he had a sportrichosis-related meningitis (a known, albeit rare, possibility), that didn’t have any affect on his mental status? They probably should have gone ahead with the lumbar puncture.

Cameron announces that Doug is free from cardiovascular disease, yet is quickly testing for carotid atherosclerosis — a cardiovascular disease.

A Holter monitor is a portable heart monitor that patients wear so that their heart rhythm can be recorded while they go about their normal daily business. It would be redundant in the hospital where all of House’s patients are already hooked up to heart monitors.

If Doug is bleeding out so much that he’s weak and fainting, a transfusion of blood might be a good idea in addition to the fresh frozen plasma.

Pulmonary sporotrichosis (from inhaled fungus) is a distinctly different form of the disease than cutaneous sporotrichosis (from superficial penetrating trauma), which is what House is describing.

His femur is broken, but everyone is focusing on and looking at his calf.

I’m suspicious that defibrillating ventricular tachycardia would be enough to raise the troponin level, at least a little bit. (From what I can find, the jury is still out on this: studies suggest defibrillating atrial arrhythmias doesn’t do much to the troponin, but multiple shocks in ventricular tachycardias do affect it).

The medical mystery itself was good again this week and deserves a B+. The final solution almost fit, but should not have been as significant a puzzle as House’s team made it, I give it a B-. The medicine was very sloppy, and even the smallest amount of research would have shown that “generic” chemotherapy was wrong. The medicine earns a D, and that’s probably generous. The soap opera was good, with Cuddy, Wilson, and Cameron/Chase all having their moments. I give it a B+.

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

There were two interlocking stories on tonight’s episode of Fringe. One of which contained a serial killer, and one of which contained Fringe science (if by “fringe” you mean “in no way connected to the actual laws of science”).

The Plot:A demolition crew is ready to implode an old building when one of them gets a strange feeling and runs back inside. He and his co-workers find a hidden basement that appears to have been sealed off for years, and in it, huddled in the corner, they find a naked, pale, bald ten year-old child.

Meanwhile, the serial killer known as “The Artist” has reappeared after a three year absence and sent a taunting note to the FBI.

Olivia and her team interview the strange child (hereafter called “Lex Jr”) in the hospital. He is having some shortness of breath and the doctor wants to put him on supplemental oxygen. Walter stops her and lets her know that Lex Jr is from a low oxygen environment and needs less oxygen, not more. Sure enough, Walter’s right and Lex Jr starts to breathe better. He seems to form an emotional bond with Olivia. He grabs her pen and writes a name upside down — and it turns out to be the name of the serial killer’s latest victim.

Olivia visits Lex Jr again, hoping for more clues about the killer. This time, he writes an address down for her. She goes to the address, but can’t find anything. It isn’t Lex’s fault though, it was Olivia’s: the murderer’s van was parked at that address and she missed it. While in the hospital, she meets a social worker who remarks that Lex Jr will likely be leaving the hospital soon.

Walter thinks he can provide a way for Lex Jr to talk. Olivia brings him to the lab where Walter hooks him up to the neural stimulator (remember that from episode five?). About this time, the social worker appears in the lab, only he’s not a social worker — he’s a CIA agent and wants the boy. He agrees to give Olivia and team one day to find the killer before he returns for Lex. With Lex’s help, and an assist by Peter, Olivia manages to track down and capture, if not kill outright, the Aritist. In the end, Olivia finds she can’t hand Lex over to the CIA and has the friendly doctor from the hospital set him up in a good foster home instead.

1. When is More Less?
The “Lex lived in a low-oxygen environment” concept bugged me. For one thing, if the hidden basement was that oxygen poor, the demolition crew would not have been able to breathe down there.
And later, when Walter tells the doctor to put Lex on 5% oxygen, what was the other 95%? Hospitals don’t keep tanks of less than 100% oxygen sitting around. If a little oxygen is needed, the flow setting is low. If more is needed, a higher flow (and fancier masks) are used. Remember, room air has 21% oxygen and if the team wants to go less than that, they’d need an air-tight room and would somehow have to remove the oxygen from it. You can’t just use a near-empty oxygen tank because all you’ll get from that are a few minutes of extra oxygen and then back to room air.

2. If a Bone Shatters, and No One is Around ti Hear It, Does It Still Hurt?
If he lived his entire life in the dark, he would not just be low in Vitamin D, he’d have rickets, a bone disease caused by long term Vitamin D deficiency.

3. Oxygen or Cautery
The machine they made a show of turning on before placing Lex on his “low oxygen” nasal canula had nothing at all to do with oxygen or air flow. It was the control panel for a electrocautery machine — which uses an electrical current to cut through tissue and/or cauterize wounds. It is a common piece of surgical equipment. You’ll notice the buttons were labeled monopolar, bipolar, and coagulate.

4. The Future’s So Bright, I Gotta Wear Shades
For someone with an extreme sensitivity to light, he was sure kept in a brightly lit room. How about some sunglasses at least.

5. Call the Amazing Randi
Let me get this straight: Lex can not only read the mind of the serial killer — oh sorry “empathize” with him — but he can miraculously express it in English, a language he cannot speak and isn’t even sure which way is up when he writes it (but he fixes that one fast). I could almost accept it if he drew a vague picture of what the killer was seeing, but for him to give a specific name or address when it’s likely the killer wasn’t even aware of them…

6. When Being Cheap Costs
The meat packing company sold used bloody drop cloths? And they didn’t find this strange? And The Artist didn’t have the common sense to spend a few bucks extra to buy clean ones?

7. Code
Ars Technica has a couple of nice articles (especially the second one) on “The Fringe Code.”

Because of the nonsensical psychic powers, the complete misunderstanding of basic science, and pretending an electrocautery machine is an oxygen machine, I have no choice but to resume the Fringe Doomsday Clock countdown, and the hands move up a minute to 11:56.

As part of her rehabilitation, Poison Ivy offers to cook you a meal. Do you:

Answers and results available below.

Read more…

After looking at the Worst Comic Book Medicine of 2008 earlier, now I’m going to celebrate the Best Comic Book Medicine of 2008.

Best Depiction of Medicine:
The hospital scenes in Blue Beetle #31.link

Best Doctor:
Doctor Mid-Nite finally got the chance to strut his stuff as the preeminent physician of the DC universe, showing up not just in the Justice Society of America, but also having medical assistance roles in Detective Comics, Blue Beetle, and Terra.

Best Single Medical or Scientific Concept:
Slim pickings again this year, but I’d say the best and most realistic medically-driven storyline this year was Sadie’s marked personality changes after suffering brain damage, as seen in David Lapham’s Young Liars series. link

Best Imaginary Medicine or Treatment:
Warren Ellis’s fascination with super-heroes and polyploidy (additional sets of chromosomes), as seen in both Ultimate Human and his run on Astonishing X-Men. link

Special Mention:
Best New Doctor: Dr. Faiza Hussain, the Excalibur-wielding physician from Captain Britain and M.I. 13.
Best Medically Accurate Art: Rags Morales in Nightwing #148.
Best Technobabble: Mandarin’s scientist in Iron Man #24, when he tried to explain how Maya had disguised the Extremis code by hiding it binarily in protein complexes in the genetic structure..

Previous “Best of the Year”: The Best Comic Book Medicine of 2007 The Best Comic Book Medicine of 2006 The Best Comic Book Medicine of 2005 The Best Comic Book Medicine of 2004

An enjoyable episode of House; one of the better of the season. A good mystery, and the medicine was generally decent. Some nice battle of wits soap opera as well.

Emmy, a thirty year-old fitness instruction, is filming an infomercial when she experiences sudden difficulty breathing and collapses, breaking her ankle in the fall. She is admitted to House’s service for evaluation and all the initial tests were normal. Taub suspects her of steroid use, Kutner mentions environmental allergies, and Cuddy suspects exercise induced asthma. The last seems the most likely, so the team sets about to recreate Emmy’s episode, the best they can with her broken ankle. Sure enough, while in the middle of exercising, she once again collapses and is found to be pulseless.

Kutner suggests she may have Carcinoid syndrome. A CT is obtained which shows no carcinoid tumor, but does reveal that she has had gastric bypass surgery in the past. This catches the team by surprise, and has them rethinking their differential diagnosis: now diabetic neuropathy (nerve damage caused by diabetes) and sleep apnea are added. Thirteen suggests gastrointestinal malabsorption leading to a low potassium, but Kutner takes it one step further and thinks Emmy may have SIBO (small intestine bacterial overgrowth) in a blind loop of bowel, and that these bacteria are making their way into her blood stream causing her symptoms. They test her stool, but there is no evidence for bacterial overgrowth or fat malabsorption.

House decides to rethink sleep apnea, and has Kutner and Taub run a sleep study. During the test she sneaks out, and the pair find her exercising on a treadmill, her ankle still in a splint. They also notice she is bleeding from the ankle and never noticed — she has lost sensation in her foot. The differential now includes multiple sclerosis, Parkinson’s Disease, and transverse myelitis (a crosswise inflammation of the spinal cord). House orders a nerve conduction velocity test (NCV), but while setting it up, Taub realizes that she is losing muscle strength in her arms. This again changes the differential, and the team considers myasthenia gravis, botulinum toxin exposure, other toxins, or heavy metal poisoning. House has them start her on chelation to treat her suspected heavy metal toxicity, but there is no change in her condition. The latest differential consists of a corornary-cardiac fistula (an abnormal connection between the coronary arteries — which supply blood to the heart muscle — and the interior of the heart), Austrian syndrome (meningitis, pneumonia and endocarditis caused by the Pneumococcus bacteria), or Guillain-Barre Syndrome (an autoimmune disease of the peripheral nervous system). The latter fits the symptoms the best, so she is started on the treatment for Guillain-Barre, plasmaphersis.

When Emmy starts hallucinating, the team realizes that the Guillain-Barre diagnosis is wrong as well. Thirteen favors a diagnosis of CNS lymphoma, but Taub is suspicious she has a prion disease (a rare type of disease caused by infectious protein particles. The best known example is probably mad cow disease). House wants a brain biopsy, but Cuddy won’t let him until they’ve ruled out other brain tumors by non-invasive means. The initial tests come back negative and House decides to perform the brain biopsy himself. However, when he and Taub enters the room, they find Emmy up and about, feeling good. Taub informs House that there have not been any new drugs, but that she did eat a piece of chocolate cake from the cafeteria. House now realizes the cause of her condition — she has hereditary coproporphyria. This is an inherited disease that House tells her can be controlled by a high carbohydrate diet. When she was fat, she ate that type of food all the time, so suffered no ill effects, but now that she is slender and eating healthy, the symptoms have caught up with her. He recommends resuming the high carbohydrate diet, but she chooses to continue her low calorie diet and take medication to control her symptoms.

Major complaints are in red, minor in blue, nit-picking in green. Overall, not too many big errors this week, but many of the diagnoses were quite a stretch.

You don’t test for SIBO with a stool study. You need an aspiration of fluid from the small intestine to evaluate or a hydrogen breath test. Plus, if she has a blind loop of bowel, how are the bacteria from it going to end up in the stool to be tested?

She was pulseless, but they never specifically said what her rhythm was. If it was asystole or PEA, then defibrillation was wrong. Otherwise, it was probably right. (And I’m still not too clear on why she coded in the first place).

The time course was off again, but in different way than usual. Emmy must have been several years out from her surgery — she had the weight to lose, the muscles to tone, the fitness guru-ness to obtain, and the informercials to produce and distribute — and only now does she start to have symptoms?
And she never had symptoms with a low carb diet while trying to lose weight before her surgery.

Diet alone is not the best treatment for severe CHP attacks. A drug known as Hemitin also helps.
A high carbohydrate diet is recommended by some physicians. Most doctors recommend a healthy balanced diet with high carbs only during acutre attacks.
Abdominal pain is a key symptom of coproporphyria.

Several episodes this season where diagnoses are made by looking at the urine color and they miss the classic purple urine in this one?

The medical mystery was good this week and deserves an A. The final solution was fairly clever, though a bit of a stretch, and earns a B. The medicine, though again quite a stretch at points, was good overall and also earns a B. The soap opera was well done, both in terms of House/Cuddy and Thirteen. I give it an A, with extra credit for Cuddy’s comment about House’s balls.

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

An above average episode of House. The medicine was better than recent episodes, though the soap opera was turned way down.

Sophia is a 16 year old emancipated minor working as a factory foreman. She sought emancipation after both of her parents were killed. While talking with a floor worker, she begins to have chest pain and shortness of breath, and then collapses, red frothy sputum flowing from her mouth.

She is admitted to the hospital for evaluation of her pulmonary edema. The initial differential diagnosis consists of parasite infection, gastrointestinal problem, pregnancy, or damage to the heart from drug use. House has Kutner perform an echocardiogram while Taub and Thirteen search Sophia’s apartment. The echo shows no structural heart disease, but the apartment search shows that she likes to build her own furniture, but it also turns up a bong. When confronted with this, Sophia claims that it is her ex’s bong, and it’s the reason that he’s an ex.

The team now considers that she may have intermittent tachycardia (occasional episodes of an abnormally fast heartbeat) due to drugs, though Kutner favors a diagnosis of vasculitis. He wants to giver Sophia steroids, but House turns him down, stating that a steroid could make an arrhythmia worse. House wants to start her on beta-blockers (a drug that lowers the heart rate) to control the suspected arrhythmia. Kutner decides to go ahead with his original plan and gives her steroids instead. A short time later, Sophia is violently yelling at the staff and having paranoid delusions. She is given Haldol (haloperidol — a potent antipsychotic) to control her outbursts. Kutner reports that labs show that her psychotic break is not due to any metabolic problem, and it was too soon to be related to the steroids.

Given the symptoms of lung problems and delirium, Foreman suggests Prinzmetal’s angina (heart pain caused by spasms of the coronary arteries) — only he suggests it involves arteries in her brain, not the heart. House thinks the idea shows promise, so has the team place her on ergonavine )a drug which can trigger blood vessel spasms) and check an fMRI (functional MRI – an MRI that looks at blood flow). Medically, this part makes little — if any — sense, but is really just used to set up the subsequent revelation. The fMRI shows no arterial spasms, but it suggests that she is lying when she talks about her dead parents. Kutner confronts Sophia and she admits that she lied about the death of her parents, and the truth is that she ran away from home because her father raped her.

The team now adds sexually transmitted disease (especially gonococcal endocarditis) and stress to her differential. House feels it is the latter and suggests that Sophia be put on diazepam (Valium) to help with the stress. As Thirteen is about to give her the medication, Foreman notes that she has reddish-brown urine which wouldn’t be caused by stress. A microscopic examination of the urine reveals “shredded red blood cells.” E.coli, Shigella, and Legionnaires Disease are all suspected, but House believes her symptoms are caused by arsenic poisoning from building furniture with treated lumber. The tests apparently support this and she is started on chelation therapy for the arsenic. After the therapy, when Sophia is ready to be discharged (which is always dangerous in House’s world), she suffers a seizure. A repeat MRI shows brain lesions that were not there just a few days before. Infection (syphilis in particular) and cancer are suggested, but shot down. Then Thirteen suggests acute promyelocytic leukemia (APL). A brain biopsy confirms the diagnosis. Arsenic is used to treat APL, so removing it from her system allowed the leukemia to spread. Giving her more arsenic may slow down the cancer, but according to House, bone marrow transplant is needed for the cure. A family donor would be best, but Sophia refuses to let them tell her parents. Disregarding her wishes, Thirteen visits Sophia’s family only to discover that Sophia has been lying and using a stolen identity. Told of this, House believes her responses are too rational and confronts her. She admits that she ran away from home because she killed her younger brother. House convinces her to contact her parents, and in the end we witness a tearful family reunion.

Meanwhile, Foreman is treating his own patient: Jonah, a four year old boy with several days of unexplained lethargy, diarrhea, and bloody vomiting. The standard tests are all normal, so Foreman proceeds with a capsule endoscopy (a swallowed wireless camera to transmit pictures of the inside of the gastrointestinal tract). As he swallows the camera, Jonah starts giggling uncontrollably with no provocation.

Foreman asks Cameron and Chase for help, and they consider meningitis, thyroid, stomach cancer, and porphyria, but all tests are negative. As they are wondering whether they should involve House, Jonah has a cardiac arrest, but is successfully revived.

Foreman does finally go to House and ask for help, but House turns him down. Commiserating with Cameron and Chase he has his own Eureka! moment when he realizes that Jonah is suffering from iron toxicity from all the extra vitamins his brother had been feeding him to make him stronger.

Major complaints are in red, minor in blue, nit-picking in green:

Once again, you do not shock a flatline.

I mentioned this above, but “Prinzmetal in the brain” to be diagnosed with ergonovine and fMRI is nonsense — and dangerous if it worked. If it did cause a spasm, then they just caused a stroke (or at least a TIA) in sixteen year old. How were they planning on correcting that?

fMRI has been studied as a lie-detector – Mythbusters featured it in one of their episodes. It doesn’t work quite as neatly as it did on the show. For one thing, small movements — like talking — will throw it off. Also, while the limbic region of the brain may house “imagination,” it is also important in emotions and long term memories — so it lighting up while talking about dead parents would be expected.

From my reading on APL, it is treated primarily with specialized chemotherapy (including arsenic trioxide) and has a very good response rate. Bone marrow transplant is not considered unless there is a recurrence.

Valium is overkill for an anxiety disorder. That class of drug (benzodiazepines) is not a bad choice for acute anxiety, but there are better choices than Valium, particularly in a sixteen year old.

I don’t know what procedure Wilson was going to perform, but it’s best to put on your surgical mask and eyewear before scrubbing.

Interesting how they immediately ruled out cancer as a cause of the brain lesions…and then ended up diagnosing APL, a type of cancer.

Neither medical mystery featured dramatic symptoms, but both were solid puzzles and earn a B+. The solutions were both logical and fit fairly well so deserve an A-. The medicine was better than the past several episodes but still had some large holes. Foreman’s case was handled better, but he was still stumbling around more than he should. Still, it was better than average (especially this season), so earns a strong B-. The soap opera aspects were minimal, though it was nice to see House interacting directly with the patient. I give this aspect another B-.

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

Continuing my medical annotations of Volume 1 of Black Jack, by Osamu Tezuka, and published by Vertical. This post looks at the six stories that make up the second half of the volume, plus the story “The Two Jans” which is found in the hardcover edition only.

Several of my favorite stories in this volume will be covered in this post. I was particularly fond of “Star, Magnitude Six,” “The Legs Of An Ant,” and “Two Loves.”

There are mild spoiler warnings for this post, but not as significant as part one of the annotations. Click on “Read More” to view the rest of the post.

Read more…

Cardochine is one of those drugs that instantly causes a fatal heart attack. Like all the drugs in this class, it shares two characteristics:

When aging stage actor Namus Shane tires of his current leading lady, he kills her with a dose of Cardochine and replaces her with a younger actress. He’s done this many times, and nobody seems to have any suspicions, even though Shane seems to be killing actresses left and right, sometimes two or three in the same week.

Luckily, the boyfriend of Kitty Martin — the young actress who Shane has his eye on as his next conquest — has appropriated some of the drugged wine that Shane uses and given it to his friend Bob Benton to evaluate. Bob Benton is not just the secret identity of the super-hero Black Terror, but he is also a super-pharmacist, able to dispense pharmaceutical knowledge faster than a speeding bullet.

Bob detects the deadly drug in the wine and suspects that Kitty will be its next victim. He changes into costume and confronts Shane at the theater. Trying to escape, Shane flees across the catwalk high over the stage, but slips and falls all the way to the ground. He manages to survive the fall, suffering just a mild concussion. A well-meaning stage hand rushes to his side and gives him a drink to revive him. Unfortunately, the drink he offers is the poisoned wine meant for Kitty, and Shane dies of a heart attack, a victim of his own drug (or maybe a victim of fatal irony, in comic books it’s sometimes hard to tell the difference).

Take Home Message: Don’t date younger actresses then try to kill them. Look both ways before crossing the catwalk. Don’t mess with drugs that cause instant fatal heart attacks because you’ll die of irony.

Storyline and images are from Exciting Comics #65 (January 1949), “Death at 8:30″

An interesting mystery and clever solution weakened by a diagnosis that requires way too much coincidence and overlooking more obvious answers.

Nicole is a 25 year old Chinese woman raised in New Jersey who was given up for adoption as a young infant. She is back in China trying to find her birth parents. While in a temple there, she suffered a sudden attack of excruciating abdominal pain and started to vomit blood. By the time she has returned to the US and been admitted to Princeton Plainsboro, the Chinese surgeons have removed a foot of bowel.

The team’s initial suspicion is a Meckel’s diverticulum (a defect in the small intestine), so House performs an ultrasound which is negative. Nicole’s biological adoptive parents arrive with her medications from her apartment and tell House that they are saddened to discover Nicole has been drinking “again.” Looking though her medications, House finds the licorice root prescribed by the Chinese doctors and deduces that they suspected she had SARS (Severe Acute Respiratory Syndrome. Some researchers suspect that glycyrrhizin, a chemical found in licorice root, shows benefits in the treatment of SARS). She is placed in isolation and started on ribavirin and interferon (other medications that some research suggests may treat SARS). House is then is kidnapped by Wilson, with help from Cuddy, to guarantee that he will be present at his father’s funeral.

While Kutner is examining Nicole, she develops abdominal pain again and he notices that she is becoming tachycardic (has a faster than normal heart rate) and has signs of liver failure, meaning that SARS is the wrong diagnosis. She is scanned and a clot is found in her hepatic vein which Chase is able to remove surgically. The team discusses what caused her to clot. Thirteen suspects she has a genetic disorder that, when combined with her heavy smoking, makes her more likely to clot. The team decides to run further tests to determine which part of the clotting cascade is malfunctioning. When Kutner goes to draw her blood, he discovers Nicole is not in her room; he finds her outside the hospital, smoking. He draws the blood for the tests, but is unable to get her to stop bleeding afterward. Ultimately it takes 6 units of FFP (fresh frozen plasma — derived from human blood, it contains a high concentration of clotting factors) to get her to stop bleeding. This combination of clotting and bleeding causes the team to suspect that Nicole has DIC (disseminated intravascular coagulation), “which means cancer,” according to Kutner.

A CT scan is obtained and shows a large fluid filled cyst in the pancreas. The team is able to get House on the phone briefly, and he mentions something about a steamroller. Trying to understand his cryptic comment, they consider pancreatic cancer, scleroderma, lupus, gallstones, and a pancreatic divisum (a fairly common anatomical abnormality, it can sometimes cause chronic abdominal pain or pancreatitis). They decide that she has gallstones, which are confirmed on CT. They call in Chase to remove her gallbladder, but when he is talking to her about the planned surgery, he notices that her urine is dark brown (a sign of possible kidney failure). Thirteen recommends running a “bubble test” and injecting small bubbles of air into the pancreatic cyst to see if they travel anywhere else. House agrees; however, when they try to run the test, Nicole has delirium tremens (”the DTs”) so bad she cannot stop shaking. The team places her in a Phenobarbital coma to run the test and help her through DTs. The bubble test is negative, but Nicole is found to have dilated cardiomyopathy and a mass in her right atrium. The team suspects a myxoma (a benign tumor of the heart), but House believes it is iron overload (he suspects one or both of her parents have hemochromatosis). He wants to check an MRI, but he has a sudden revelation and stops Taub from running the test just in time. A simple x-ray of the head shows Nicole’s problem — nails in her brain. It seems her birth parents did not want her as a child and pushed iron nails into her brain through the fontanelles (the “soft spots”) in an attempt to kill her. When that didn’t work, her father secretly gave her up for adoption. She encountered a hidden magnet in the Chinese temple where her symptoms began — a magnet that moved a nail onto a section of the brain that stimulated abdominal pain. House stopped the MRI because the magnet in the machine would have ripped the nails through the brain. Though it’s not explicitly stated, the rest of her symptoms (basically everything but the abdominal pain) were caused by the iron overload (from the iron nails in her brain), which apparently hit full force at the precise moment the nail shifted. What a coincidence!

Major complaints are in red, minor in blue, nit-picking in green:

A diagnosis of DIC does not equal a diagnosis of cancer. There are many other causes of DIC including infection, trauma, major surgery, burns, obstetrical complications, liver disease, and heatstroke.
DIC causes clots in small blood vessels, not large ones like the hepatic vein.

Nicole had abdominal pain and was vomiting blood. Other than an occasional cough, what lung symptoms was she showing that caused the Chinese to treat her for SARS and House to mention the lungs as a source of her symptoms?

I’m suspicious of Thirteen’s “bubble test.” While there is a bubble test that can be used to find heart defects, it is only used on a relatively small single organ. Thirteen’s idea of trying to track microscopic bubbles wherever they may go over the entire body seems fruitless, especially when the overlying gastrointestinal tract is likely to have gas bubbles of its own. Plus this would only work if the cysts were connected.

Delirium tremens was only addressed superficially in the storyline. It is a life threatening condition, and tremors are only a small part of it. Nicole had the rapid heart rate and the tremors, but none of the other symptoms, so the diagnosis seems premature.
Phenobarbital is not the recommended treatment for delirium tremens; Benzodiazepines are. But then, House has made this mistake before.

Nicole’s symptoms didn’t really match Meckel’s, but then it’s a tricky diagnosis and hard to make. Usually it presents with rectal bleeding, and then a technetium scan is the best choice. In cases where there’s no bleeding, an Ultrasound is the best test.

What a pleasantly convenient finding that Nicole has a nail in the “addiction center” of the brain which explains away all of her bad habits.

CT scanners don’t beep when something weird shows up.

The medical mystery was fairly interesting, so earns a B. The final solution of the nails was clever and unexpected and is awarded a B. The medicine, while better than the past several weeks, relied way too heavily on coincidental timing — even for House – and only earns a B-. The non-medical soap opera aspects of this story were by far the best part, from Cuddy tranquilizing House, to the House/Wilson moments, to Hanson, and earns a solid A.

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

A fairly ho hum episode of House, with far too many red herrings and not enough real medicine.

Brandon is, at best, a mildly successful artist. At the beginning of the episode, he is painting a portrait of a woman, but when the woman and her husband take a look at the finished product, they are shocked because the subject in the painting is horribly distorted. Even stranger is the fact that Brandon cannot tell that anything is wrong; the portrait looks completely normal to him.

Brandon is admitted to the hospital for evaluation of his acute onset visual agnosia. The initial differential diagnosis include stroke, brain tumor, drugs, or environmental toxins. An initial MRI was negative, but House wants an MRI with contrast. He also sends Taub and Kutner to search Brandon’s apartment for toxins. The search turns up nothing suspicious and the MRI is negative.

Toxins and drugs remain on the differential diagnosis, but a cavernous angioma of the brain (large, abnormally dilated blood vessels in the brain) has been added as well. When Brandon shows little emotion when told he requires a risky surgical biopsy, House deduces that he is hiding something. It turns out that he has had to make ends meet by enrolling in clinical trials of new drugs. He is currently a participant in three separate drug trials. House assures him that his symptoms were due to the experimental drugs, and since they should be out of his system by now, he’ll be discharged in the morning.

As usual, being discharged from Princeton Plainsboro is a sign of problems to come, and Brandon has a sudden seizure. By now, the team has discovered what drugs Brandon was being given: an anticoagulant, an autoimmune drug, and a statin (a cholesterol medication). They suspect the interaction of all three drugs is causing his symptoms and House elects to give him dialysis to clean all the drugs out of his system. It seems to work at first, but then Brandon develops massive swelling of the tissues of the head and neck occluding his airway. Foreman performs an emergency tracheotomy and Brandon is started on steroids. The differential now includes a thrombosis, Chagas disease (both of which would block the venous drainage, causing swelling), infection, or cytokine storm, with the team favoring the latter. House and the team are unsure whether the cytokine storm is a withdrawal symptom from the experimental drugs, or a new symptom entirely. To solve the puzzle, House elects to put Brandon back on all three drugs, and then wean them off slower this time.

Once again, withdrawing the drugs seems to work at first, but then it becomes obvious that Brandon’s libido has been put in overdrive. A punch to the nose from Dr. Thirteen solves that problem, at least temporarily, but it is a new symptom to consider. Kluver-Bucy Syndrome (a condition caused by damage to both temporal lobes of the brain) is suspected, and an MR Angiogram is obtained to get a closer look at the blood vessels. It shows some narrowing of the vessels of the Circle of Willis (the main arteries supplying the brain). That should not be enough to cause symptoms, but Taub suspects there may an underlying cardiac arrhythmia that worsens them. An EP study (electrophysiology study — it looks for abnormal conduction in the heart) is ordered, and is decidedly positive. During the test, Brandon goes into ventricular tachycardia and needs to be defibrillated. At this point, House notices that Brandon’s hair is turning red around the temples.

Kluver-Bucy is abandoned and Waardenburg Syndrome is suggested, but when Kutner notices a prolonged QT on the EKG (a potentially dangerous heart rhythm), the suspicion shifts to Romano-Ward Syndrome (a common inherited form of Long QT Syndrome). A cardiac sympathectomy (a surgery that reduces the effect of the sympathetic nervous system on the heart) is ordered. When Brandon once again develops visual agnosia, Taub begins suspects the symptoms may be due to lingering toxins, and seeks out Brandon’s old paintings. The paintings show the same distortion every other month — the same time he was on all three experimental medications together. It turns out that in a previous research project, Brandon had been on an experimental antacid which allowed the formation of a bezoar in his stomach. This bezoar trapped many of the experimental pills and has slowly been releasing them, causing Brandon’s symptoms even though he has not been taking any new medications (which means the team had it right halfway through, it was the combination of the experimental drugs, and the last half of the episode was spent chasing one red herring after another. After all, who can argue against the symptoms of “experimental drug reaction”?) The bezoar is removed surgically and Brandon should be good as new.

Major complaints are in red, minor in blue, nit-picking in green:

Romano-Ward is NOT caused by five separate gene mutations. It is caused by a mutation in any ONE of five (actually six) particular genes.

That’s a weird type of agnosia Brandon is experiencing, if it’s agnosia at all. He seems to recognize people and things (at least initially), but can’t paint them – which makes it more of an expressive aphasia than an agnosia. Later on in the show, it shifts entirely and he now can’t recognize people he should, which is a type of agnosia.

None of the neurological syndromes or conditions the team mentioned fit the pattern, but again, why have a logical pattern when it can all be explained away with “experimental drug reactions.”

The standard treatment for prolonged QT interval (including Romano-Ward) are beta-blockers or an ICD, treatments that Brandon can’t have, with no good explanation given as to why.
A sympathectomy is a legitimate treatment for prolonged QT syndrome if the beta-blockers and ICD fail

Why is Taub, a plastic surgeon, running an EP study? It requires not just a cardiologist, but a specially trained cardiologist.
But he’s better than Kutner. Shocking v-tach at 60 and then 120? Wrong.

Most phytobezoars can be non-surgically removed (91% by a recent study).

With swelling of the mouth and pharynx, a standard intubation is difficult, so a tracheotomy makes more sense this week. The procedure was surprisingly smooth for a patient that swollen (no landmarks) and for a doctor who doesn’t do them regularly.

Once again, no eye protection during surgery.

The medical mystery was moderately interesting, though annoyingly inconsistent, so earns a B-. The bezoar was clever, but the final solution relied too much on mysterious experimental drugs and their interactions rather than actual potentially-interesting medicine, so only earns a C-. Most of the medicine was flawed, and the rest “experimental”, but it was still better than last week so earns a D+. The soap opera was better. The Taub part was good, House’s names for the experimental medications were fun, but I didn-t buy any of the Cuddy/PI/House interactions. I give the soap opera a C+.

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

This episode of Fringe, at least from the science and medicine point of view, was an improvement over the first two. Sure, it was still rubbish, but the cringe factor was less.

The Plot: A man boards a bus in Washington D.C. and makes eye contact with another passenger. When she puts the backpack she was carrying down on the ground, the man dons a gas mask and opens a capsule of mysterious gas. In the resulting confusion, he grabs the backpack and escapes the bus. After he leaves, the gas on the bus becomes a solid gel, completely filling the bus, suffocating and trapping everyone inside. Called to the scene, Dr. Bishop identifies the gel as a aerosolized silicon base that polymerized with the nitrogen in the air, and is able to recreate it in the lab.

Meanwhile, a mild mannered office worker named Roy McComb has been having Pattern-related visions for the better part of the past year. Dr. Bishop suspects that Roy is psychic. He ties it all in to an old project of his, the Ghost Network, which uses wavelengths “lying outside the range those already discovered” to transmit secret information. It turns out that Roy was one of Bishop’s experimental subjects twenty years before when he was trying to use “iridium-based organometallic compounds” to create a living receiver for the Ghost Network. Somehow, in the intervening years, those metallic compounds have multiplied and collected in Roy’s visual cortex (the part of the brain that translates visual input). Thus, when someone uses the Ghost Network, it gives him visions. Bishop wants to move the metallic compounds from the visual cortex to the auditory cortex so Roy can hear what is being said on the Network rather than see it in visions. Agent Dunham uses the information obtained through Roy’s abilities to capture (or at least attempt to capture) the people responsible for the bus attack. In the scuffle, she is able to recover the strange object they were after.

1. The Jell-O Bus
Is that small an amount of silicon gas really going to fill the entire bus up with gel? No, not even if it combines with nitrogen. Sure, nitrogen makes up 75% of the air on the bus, but those molecules are spread out because it’s in gaseous form. If they did condense into solid form, the nitrogen molecules would take up dramatically less space because solids are much more condensed than gases. Even if you throw in the amount of silicon gas in that canister, there still wouldn’t be enough mass to fill the entire bus with gel.

2. Dr. Bishop, Pharmacist
Dr. Bishop takes his own homemade concoction of dextromethorphan, Klonopin, and fluoxetine.
Dextromethrophan is synthetic narcotic used as an over the counter cough suppressant (it is the “DM” in Robitussin DM), and can be hallucinogenic at high doses.
Klonopin (clonazepam) is an anti-anxiety agent and sedative. IT is a benzodiazepine, the same class as Valium.
Fluoxetine is the generic name for Prozac, an anti-depressant/anti-anxiety medication.
None of these are psychotics (or even anti-psychotics) as Peter suggests.

3. Ghosts or Visions
For the sake of argument, let’s say the iridium compounds in Roy’s brain did react to the Ghost Network. That still doesn’t explain why his brain would interpret the signals as exact visions or the exact words. It would more likely result in random auditory or visual hallucinations, or possibly a seizure.

4. Magnets
Wouldn’t the MRI, an extremely powerful magnet, already have shifted the metallic elements out of Roy’s visual cortex.? If Dr. Bishop’s little homemade magnetic machine can, then certainly the much stronger MRI would have.

5. Cleanliness is next to Godliness
If a mad scientist ever drills in my brain, I would hope that — unlike Dr Bishop — he (or she) would at least use sterile technique.

For those of you too young to remember (including me), Ben Casey was a medical television show that ran on ABC from 1961 to 1966. It starred Vince Edwards as Dr. Ben Casey, chief neurosurgery resident at the hospital “59 West”. Striking while the iron was hot, Dell published ten issues of a Ben Casey comic book from 1962 through 1965. Today’s story comes from the first issue of that title, published in June/July 1962.

Doctor Ben Casey is about to head out for a night on the town (his version of a night on the town, that is: a neurosurgery convention) when he is summoned to an emergency case. The police have discovered a man who was struck by the subway. The impact only caused superficial injuries, but witnesses report that the patient was acting strange before the accident, so he was brought to the hospital for evaluation.

Dr. Casey examines the patient and suspects that he has a hematoma which is causing an increase in intracranial pressure, leading to the bizarre behavior. Casey wants to proceed with surgery, but the patient refuses. In fact, he refuses treatment of any sort, and even refuses to give his name to the hospital staff. He becomes paranoid and then starts acting out violently. Casey decides his best option is to sedate the patient.

About this time, a blond shows up in the hospital and identifies the patient as Roy Thorne, her husband. She tells Dr. Casey that Roy is a construction worker and was injured on the job several days ago. He refused to seek medical treatment and he has been acting more paranoid and more violent with each passing day. She reports that he nearly strangled her this morning. Dr. Casey explains the diagnosis to Mrs. Thorne and has her sign a consent for the surgery. However, when he goes to prep the patient for surgery, Casey discovers that Roy has escaped the hospital.

Dr. Casey reasons that Roy will head for his apartment, so he gets the police to join him and Mrs. Thorne there. Sure enough, Roy shows up a few minutes later. His wife tries to slip him a sedative in a cup of coffee, but he doesn’t drink it. He accuses her of trying to kill him and threatens her with a broken bottle. The police and Casey rush in and secure and sedate Roy. He is rushed to the surgery and Dr. Casey is able to successfully drain the hematoma and relieve the pressure on the brain. When Roy wakes up he reports feeling the best he has in days and apologizes profusely to both the doctors and his wife. His patient cured, Dr. Casey once again heads out for a night out — at the neurosurgery convention.

I’m amazed at how every patient who goes to 59 West seems to end up on the Neurosurgery Service. I suspect that if you showed up there with an ingrown toenail, you’d be admitted under Neurosurgery and Dr. Casey would want to perform brain surgery. This patient is a good case in point — someone with “mental status changes” may end up a neurosurgery patient, but shouldn’t start out there.

Some questionable ethics aside (sedating the patient at the drop of a hat, and even getting his wife to do the dirty work — not to mention, how do you know it was really his wife?), this is a solidly entertaining comic with just enough medicine to whet the appetite. The art, unfortunately, is not nearly as good, reusing the same stock poses — the same art, actually — over and over again. (Recognize the art in the first panel? How about now?)

Sadly, there is no Dr. Dan Dazzler back-up strip in this issue: he doesn’t show up until the second issue.

Previous Flashback Weeks

Iron Man #28 “Haunted”
Daniel and Charles Knauf, writers
Roberto de la Torre, penciler

I’ve picked on the Knaufs more than a few times during their run on Iron Man, but this time, they have it right — or at least mostly right

Tony Stark: Target pencil-laser to bisect calcaneus diagonally from tendo calcaneus to tibialis posterior tendon.

In order to remove the device around his ankle that’s stopping him from accessing his Extremis suit, Tony Stark has decided to cut off his heel.
The calcaneus is the large bone that makes up the heel.
The tendo calcaneus is an older term for the Calcaneal Tendon, better known as the Achilles Tendon.
The tibialis posterior tendon comes off the (wait for it) tibialis posterior muscle — one of the deep muscles of the lower leg. It wraps around the calcaneus on the inside of the ankle before inserting on the navicular bone (wih smaller insertions on some of the other foot bones).

Based on the art, it looks like Tony is cutting the calcaneus from the point where the Achilles Tendon first meets the calcaneus to the point where the posterior tibial tendon inserts on the navicular, which more or less matches what he is saying — though if I were cutting part of my anatomy with a laser I’d be very specific about where to cut so mistakes weren’t made.

(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

There are quite a few comic characters who are animals raised up to human levels, but it rarely works the other way – there are only a handful of human characters who have truly taken on animal characteristics. Sure, there are those who dress up as animals (cough Wolverine cough), and the occasional lycanthrope, but few who are actually part animal.

Azrael was one of these characters, and a rather perplexing one. For those of you who may not remember, Azarael (real name: Jean Paul Valley) was a supporting character in the Bat-books of the ‘90s and even he had his own eponymous title for a number of years. Valley was a member of an obscure religious order — the Order of St Dumas — who had been trained and brainwashed since birth to become the ultimate assassin and “avenging angel” of the order. While investigating his origins, Azrael also discovered that he was more than human, or depending on your point of view, less than human. He was endowed with animal genes — strongly implied to be from the great apes — to increase his “physical prowess” and “cunning.”

Ras Al Gul gives Azrael the bad news in Azrael #30	The Gray Abbott explains what Azrael gains from his animal genes in Azrael #7

First of all, I was not aware that there is a gene for cunning. I’ve always thought intelligence was more multifactorial — definitely some genetic components, but with a great deal of experience and learning involved as well. (Or maybe he’s like the Tony Stark from Ultimate Iron Man with extra brain scattered throughout his body.) Regardless, I’m not sure there are any animals more cunning than humans — especially at Azrael’s chosen task — assassination (sure, other animals kill, but how many kill out of spite, or because someone else told them to?)

I’m no simian expert, but the great apes certainly do seem to have more “physical prowess” than humans — at least in their own environment. But replicating that is not just as simple as swapping muscle genes. Muscles don’t act alone; they need proper bone and nerve structure to function. It does little good to have “enhanced” ape muscles without the correct skeleton to support that – yet Azrael is always shown with a classic human build. I also question how much value animal genes would have in an urban environment (unless they were pigeon, cockroach, or squirrel genes).

The Gray Abbott explains how Azraels are made
(from Azrael #7)

It’s a little unclear how Azrael gained the animal genes. The Gray Abbott (the head scientist of the Order of St Dumas) explains that when an Azrael is created, a live human fetus is taken from its mother and gestated in a vat of ape amniotic fluid. That’s…rather disgusting, but amniotic fluid doesn’t transfer genetic material so it wouldn’t explain the animal genes.

Scott Beatty, in the Batman: The Ultimate Guide to the Dark Knight states “as a developing fetus inside a glass womb, Jean Paul’s brain and blood chemistry were genetically intermingled with animal fluids to enable greatly enhanced strength and agility.”

Again, that’s disturbing, but doesn’t explain how Azrael ended up with animal genes — but then a lot of it is technobabble…how exactly does one “genetically intermingle” fluids? There had to be more to it than just mingling amniotic fluid.

Tags: comics medicine azrael batman genes ape

In my previous discussion of brains and comic books, I neglected to mention a key concept: The Kryptonian Brain Cell Transplant.

It all starts when Linda Danver’s boyfriend David jumps into a swimming pool to save another swimmer, but strikes his head on some underwater debris, suffers brain damage, and falls in a coma.

Supergirl, of course, realizes that just because “no power on earth” can save David doesn’t mean that no one can. She rushes off to the Fortress of Solitude to talk with the scientists from the bottled city of Kandor, certain that Kryptonian science can save her boyfriend (along the way, she rationalizes that she and Superman only turn to the Kandorians in the direst of emergencies¹). Eminent Kandorian scientist Professor Ron-Kar tells her that only a Brain-Cell Transplant can save David.

The Professor arranges for Supergirl to obtain the Kandorian surgical equipment necessary to perform the transplant (made of Quasi-energy, so that only Superman or Supergirl can use them²). Supergirl first uses the tools on herself to obtain “thousands of super-brain cells”, and then transfers them into David (you’ll also note that the Professor falls victim to the 10% Myth here).

The operation is a success and David survives! Unfortunately, he’s not quite what he appears. Instead of being an ordinary graduate student, he is instead a criminal gang leader masquerading as a graduate student for cover. He’s dating Linda not because he cares for her, but because he thinks she’ll make a good alibi for him (poor Linda/Supergirl, she never could find a good date). He discovers that the brain cell transplant has not only saved his life, but also granted him superpowers just like Supergirl. He puts on a lead mask³, calls himself the Super Scavenger, and robs a bank. Supergirl quickly catches up to him.

They battle, but David’s super powers are only temporary (much like Superman’s blood transfusions), and Supergirl is able to capture him and turn him over to police. But there goes her date for the weekend…

This medical case study comes from the the physicians at the Vandyre Clinic, Kandorian Professor Ron-Kar, and Supergirl #4 (by Bates, Saaf, and Colletta)

---

Notes:
1. This is a little ironic coming from Supergirl who seems to call on Kandor for help every other issue. She has an awful lot of dire emergencies — most of which seem to revolve around boys.
2. Which doesn’t explain why the Kandorians have them or how they use them since they don’t have super powers.
3. He wears the mas so Supergirl won’t be able to figure out who he is. While she may be unable to see through the mask, she is able recognize David’s watch. Today’s take home lesson for would be super-villains: avoid over-accessorizing.

Tags: comics medicine brains supergirl transplant kandor

I like the idea of Extremis, but the more the Knaufs try to explain it, the more nonsensical technobabble we get. Technobabble always catches my eye, but since this is biologically-based technobabble (technobiobabble?), it’s gets special attention.

And then to top it off, our bad guy scientist throws in an outlandish metaphor to explain it all:

Scenes from Iron Man #24. Script by Daniel and Charles Knauf, pencils by Butch Guice.

Tags: comics technobabble extremis iron man

So there’s a rumor going around that Tony Stark may be a Skrull. Original idea, right?

Not so much, it turns out. Here’s a page from Iron Man (Volume 2) #13:

Admittedly, this is from the horribly screwed up “Heroes Reborn” universe — and on top of that, it’s from the “let’s take a bad idea and make it even worse” issue where the Heroes Reborn universe is amalgamated with the Wildstorm universe (hence the Daemonite reference) — so it’s not a particularly well-remembered (or even well liked) storyline.

So if Tony Stark winds up being a Skrull, remember you heard it here second — and in Iron Man #13 first, ten years ago.

Of course, now that I look at the scene again in the light of day, I notice that the Skrull brags about how Iron Man’s armor protects him from detection from humans, but when he reverts back to Skrull form — his “armor” reverts as well — which means he wasn’t even wearing the armor he was bragging about in the first place.

Tags: comics iron man tony stark skrull heroes reborn skrull wildstorm

How big a plot point was Tony Stark’s injured heart in the first few years of Iron Man’s adventures? It was rare to find an issue that didn’t mention his heart at least once, if not twice or three times. And not just “mention it” as much as pound home the plot point over and over and over again. That Stan Lee — not much for subtlety, was he?

From Iron Man’s first two years of solo adventures, Tales of Suspense #39 to Tales of Suspense #72, comes a little collage I like to call Tony’s Telltale Heart:

Tags: comics medicine iron man tony stark heart tales of suspense

I can’t decide if Tony Stark has an extremely healthy heart, or a very unhealthy one.
♥ First, he gets an irremovable piece of shrapnel embedded in it (scene on the left, from his first appearance in Tales of Suspense #39), which was one of the reasons he invented the Iron Man suit (and was the source of his trademarked Marvel Angst™ for his first hundred or so appearances).
♥ Then, he had a “serious acute myocardial infarction” — in other words, a major heart attack (scene on the right from The Mighty Avengers #6)
♥ Not to mention all that alcoholism puts a big strain on the heart.

So…does he have a bad heart from all the damage, or a good one because he survived all of it?

Tags: comics medicine iron man tony stark heart heart attack

It’s that time of year again: time to look back on the absolutely worst examples of comic book medicine, both real and imaginary, over the past year. I thought it was going to be a light year (tomorrow’s “Best Comic Book Medicine of 2007″ certainly is), but it turned out to be a very good year for bad medicine after all…

Worst Depiction of Medicine:
The last six months or so of The Amazing Spider-Man have managed to contain horrible medicine in every single issue, starting with Back in Black and continuing through One More Day. It’s gotten to the point where I was too sick of the multiple errors and basic misunderstandings of medicine to even comment on every single issue…though at some point I’m still going to need to vent over Amazing Spider-Man #544 (the first part of One Day More, with that whole “move Aunt May to the charity ward.”)

Worst Doctor:
Henry McCoy is by far the worst medical doctor of the year. His biggest mistake was suggesting a lethal dose of the chemical pyridine to treat a coma (in reality, not a treatment at any dose), but he also showed confusion over the difference between genes and chromosomes. I also noticed that he showed a strange predilection for recommending medications that are common in the UK, but not in the U.S. — but I suspect that has more to do with the writer being British (and it’s not an error, I just find it amusing).
Doctor Strange takes second with his “homeopathic” spell casting in New Avengers #28.

Worst Single Medical or Scientific Concept:
Black Adam’s transfusion in the recent Black Adam #4 showed a misunderstanding of blood types, and how they function.
A close second was Nocturne’s stroke in New Excalibur. There’s a distinct difference between an embolic stroke and a hemorrhagic stroke, with different causes and different treatments. Each issue — at time, each page — flip-flopped on the type of stroke she had. It was explained one way once, a different way later, and neither matched her treatment.

Worst Imaginary Medicine or Treatment:
Iron Man wins this one for his technobabble in Iron Man #14 about how he managed to fool Spider-Man’s spider sense.

Dishonorable Mentions:
Bad CPR was a theme this year, most prominently in The Initiative #3 and The Ultimates 3 #1.
Another overused theme was the unscrupulous testing of pharmaceuticals on unsuspecting patients.
The return of the Magic Cast.
The seemingly magical rib-penetrating dagger in 52 #48.

Tomorrow, the “Best Comic Book Medicine of 2007″.

Previous “Worst of the Year”: The Worst Comic Book Medicine of 2005 The Worst Comic Book Medicine of 2005 The Worst Comic Book Medicine of 2004

In this scene from Iron Man #23, Tony Stark is explaining how the super-villain Graviton managed to commit suicide by using his powers. He cuts an imposing figure with all his expensive technology, but there’s a significant mistake in the scene…

Iron Man #23 script by Charles and Daniel Knauf, pencils by Butch Guice

Previous picture quizzes

Tags: comics iron man gravitron picture quiz

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

Endangered Species, Part 9
Christos Gage, writer
Scot Eaton, penciler

For the sake of argument — and comic book science — I’m willing to accept the face that there is a single “mutant gene” — the x-factor — that is present in all mutants. It has vastly different effects in different people, but it is a single gene.

However, in this exchange with the Dark Beast, Henry McCoy suggests that there is not just a mutant gene, but a mutant chromosome. This is a completely different kettle of fish. A chromosome consists not of a single gene, but hundreds — if not thousands — of genes, along with regulatory DNA, junk DNA, and various proteins.

A human has 46 chromosomes (23 pairs of chromosomes, 1 chromosome from each pair is inherited from each parent). If McCoy’s statement is correct, then mutants have 47 chromosomes — an odd number. That really screws up reproduction, inheritance, and meiosis, which rely on equal pairs of chromosomes to work right. It also makes be wonder why it took Marvel Universe scientists decades to find a blood test to detect mutants — an extra chromosome is hard to miss.

All this speculation is probably moot because most likely McCoy (or Gage) just misspoke and meant to say “gene” instead of chromosome. (…or else the mutant genome is more screwed up than I ever possibly imagined.)

I was also planning to rebut Hank’s bad HIV analogy (mainly that HIV is undetectable because there only a few copies hidden among the millions of cells of the human body, as opposed to the fact that each one of these millions of cells* has a copy of every gene), but the Dark Beast calls him on it in the next panel. When the Dark Beast smacks down your analogy, you know it’s a bad one.

Finally, let me just point out the irony of Henry McCoy, whose teammates include a man who shoots optic force beams from his eyes — Newton be damned — and another who has wings a fraction of the wingspan required to fly, dismiss something as “not scientifically possible.”

*Not counting red blood cells, which lose their nucleus (and thus chromosomes) early in their lifespan.

Tags: comics medicine x-men henry mccoy chromosome gene endangered species

Fantastic Four #549 “Reconstruction Chapter 6: So I guess You’re Saying the Honeymoon’s Over”
Dwayne McDuffie
Paul Pelletier

In a memorable and clever scene from Fantastic Four #549, Sue Richards puts the fear of God into the Wizard by threatening his life. More specifically, she threatens to use her powers to block his coronary arteries causing a massive heart attack. (Now is Sue making a real threat, or just bluffing? I leave that up to you).

Click here or the image on the right for the full scene.

♥  This is a good example of what I like to call “medicine on the attack”: characters who have enough knowledge of anatomy and physiology to cause significant damage when using their powers in a certain way. Iron Man and Battalion are two others who have made use of similar tactics. The heart always seems to be the target, but that makes sense because everyone knows where to find it, how important it is, and roughly how it works. The same can’t be said for most of the other organs (“Be careful Mole Man, or I shall crush your spleen!” just doesn’t carry the same weight) . I’ve also noticed it’s the “heroes” who are the ones making this type of attack.

♥  Despite what the Wizard says, it’s technically not a thrombosis because that refers specifically to a blood clot. You can’t fault him much for the wrong answer because no one has coined a medical term to describe an invisible forcefield blocking an artery.

♥  Sue’s plan is a little overkill. Blocking the three main coronary arteries (left anterior descending, circumflex coronary artery, right coronary artery) is more than enough to cause a fatal heart attack. Knocking out the left anterior descending alone should do the trick — it’s called the widow maker for a reason.

♥ The art looks a little misleading at first. In real life, the heart and lungs aren’t just sitting there free in the chest — they are both covered by tough protective membranes (the pericardium for the heart, and the pleura for the lungs). There’s a simple explanation though: Sue must have turned them invisible, just as she turned the Wizard’s skin and ribcage invisible. Overall, Pelletier’s command of thoracic anatomy is quite impressive.

♥ Personally, I think an even better tactic against the Wizard would be to threaten him with a stroke. Sure, threatening him with a heart attack puts his life at risk, but threaten him with a stroke and it’s his brain — his raison d’etre — that’s on the line. Just replace Sue’s comment about the coronary arteries with this line: “A man as smart as you surely knows what happens if I used a force field to close your carotid arteries.” He’d probably die of fright right there on the spot.

Tags: comics medicine fantastic four sue richards wizard heart attack

It’s prime ragweed and hay fever season here in the Mid-West. My most common reason for patient visits this week has been allergies.

Allergies are no fun for anyone, but there’s definitely certain characters for whom allergies would be even worse. Here’s the list I came up with:

Tigra
Doctor: “I’m sorry Ms. Grant, but you’re allergic to cats.”

Thor
“Forsooth! Mine sneeze hath leveled that house!”

M.O.D.O.K.
Just imagine all the snot that would come from that giant nose. Come to think of it, I’m actually surprised that no one has written a story where M.O.D.O.K has allergies (or would that be M.O.D.O.S.* or M.O.D.O.R.N.I.E.S.**?).

Dr. Doom
Just try sneezing inside a metal face mask. Would also apply to Iron Man, Crimson Dynamo, War Machine, etc. etc.

All-star Batman
“I’m the godd – ACHOO!! I’m the go – ACHOO!! I’m the – ACHOO!! Eh, forget it.”

Superman
Itchy, watery eyes interfere with x-ray vision. If you want to rob a bank in Metropolis, do it during allergy season.

Madrox
Every time he sneezes, a double is formed.

Wolverine
Hard to track by scent when you’re all stuffed up.

The Human Bomb
Pretty self explanatory.

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*Mental Organism Destined Only for Sneezing
**Mental Organism Destined Only for Runny Nose, Itchy Eyes, and Sneezing

In the far future universe of the Legion of Super-Heroes, the people of the planet of Winath share a peculiar trait — twins. The vast majority of births on Winath are fraternal twins and singleton births are very rare, and generally pitied.

Medically, fraternal twins occur when a woman releases two eggs in a given cycle instead of the normal one, and both are fertilized and implant. Fraternal twins are also known as dizygotic twins.

No definitive explanation for the increased rate of twins of Winath is ever given. It goes without saying that this is a comic book about the distant future, so there are hundreds — if not thousands — of possible causes ranging from Dominator super-tech to Modru’s magic. There are two possibilities that seem much more likely than the rest, however: genetic mutation and environmental influence.

1. Genetic Mutation
The people of Winath could have a genetic mutation that results in women producing two eggs per cycle instead of one, making fraternal twins much more common. It’s not an unheard of idea — there are certain ethnic groups around the world today that have a higher percentage of twins than normal. If you also consider the Founder Effect, which allows uncommon genetic traits to flourish in small isolated populations (such as an interstellar colony), and realize that having twins would be considered a positive survival trait (more offspring than those without the gene), the genetic mutation explanation make sense.

If the genetic mutation theory were true, then historically you would see a slow increase initially in the number of colonists with twins, followed by a geometric increase once a certain critical mass is reached. Winathian women who moved to a different planet would still bear twins, and non-Winathians who moved to Winath would not bear twins (well, no more than the normal human rate).

2. Environmental Influences
There could be something in the environment on Winath that causes women to release two eggs per cycle instead of one. We know that there are environmental influences on Earth that can have a drastic influence on the fertility of lower forms of animals, so it’s conceivable that somewhere in the Universe there could be an environmental exposure that affects human fertility. Winath could be that place.

If environmental factors were the cause of the twins, then historically,\ we would see a drastic rise in the number of twin births almost immediately after the founding of the colony. If a Winathian woman moved to a different planet she would no longer have twins, and a non-Winathian woman who moved to Winath would have twins.

So which explanation is it?
As much as I like the elegance of the mutation theory, I’m going to have to go with the environmental theory — because of Saturn Girl. Imra Ranzz (nee Ardeen) is a native born Titan, so she would not carry any Winathian twin-mutation — yet after marrying a Winathian she gave birth to twins (twice, if memory serves). Remember, after she and Garth were kicked out the Legion, they spent a significant amount of time ofn Winath, so she would have had the chance to be exposed to whatever environmental fertility influence exists there. Of course this is two continuity reboots ago, so things could have changed.

Tags: comics medicine legion of super-heroes winath twins

Comics publisher EC took a substantial PR hit in the 1950s thanks in large part to psychiatrist Frederic Wertham’s book Seduction of the Innocent and anti-comic book congressional hearings. They gave up publishing their crime and horror comics, and instead switched to a “New Direction,” publishing comics designed to be more informative and inspirational. This concept never met with much success, and within a few years, the “New Direction” had failed and Mad Magazine was all that was left of a once successful comic book publisher.

M.D. was one of the “New Direction” comics. According to the preface of the first issue, M.D. was written to “contain stories of people…people who are helped by their Family Doctor and his associates in the Medical Profession. It will deal frankly and honestly with the diseases and misfortunes that beset people. It will deal graphically and candidly with the treatment they receive. At times, the stories will be poignant…at times they will be sad…at times they will be grim. But at all times, they will be true to life!”

Every issue of M.D. featured several realistic medical stories, each focused on a particular disease or condition. Issue #5 was the final issue of M.D. and frankly, it shows. The art is as intricate as always — if a little sensationalistic at times (particular when focusing on the grieving mother in the forefront of the panel, her fingers thrust worriedly at her lips) — but the stories are not nearly as compelling as in earlier issues, rather humdrum actually, which is unusual for any EC comic.

“Complete Cure” is the first story and tells of Philip Stuart, who had both of his legs amputated after an automobile accident. He takes the loss of his legs hard and decides to give up on his education and job, much to the concern of his wife and family doctor. In the end, Philip is introduced to another man who lost both of his legs (on the beaches of Normandy during D-Day, which pretty much trumps every other reason), but went on to become a successful surgeon. This inspires Philip who agrees to return to college.

The second story is “Child’s Play” and concerns Jimmy, a young child. He has gone deaf due to audiosclerosis (known as otosclerosis now) and needs an operation and a hearing aid to regain his hearing. His mother refuses, fearing that the other kids will make fun of Jimmy. Eventually, her husband steps in and sends Jimmy for the surgery. It’s a success and Jimmy’s hearing is returned. His mother still won’t let him play with his friends because she is convinced that they’ll reject him. One day she returns home from shopping and finds Jimmy missing. Fearfully, she runs down the street calling out his name, only to find him in the neighborhood clubhouse happily playing with the other kids, his hearing aid an object of interest, not scorn.

The third story, “Emergency” shows what happens in a hospital when a bad storm hits, knocking out both the power and emergency generators. By working tirelessly, the doctors are able to save everyone and even manage to perform an emergency surgery by flashlight. They end the story lamenting the fact that medicine has become so dependent on technology. Bear in mind that this was written over 50 years ago, and their medical technology consisted mostly of lights, x-ray machines, and iron lungs. The doctors of this story would be devastated to learn that modern medicine’s dependence on technology has increased a thousandfold since those halcyon days of not so long ago.

The fourth and final story deals with George Gordon. He is convinced that he has appendicitis, but his family doctor suspects otherwise. He believes that George has somatization disorder, and his depression is the root cause of George’s abdominal pain. George leaves in a huff and visits another doctor and hospital, but is told the same thing. Despondent, he threatens suicide but his family doctor is able to talk him down off the ledge and get him the help he needs. Based on my experience, somatization is never quite this easy to diagnose or treat, plus George seems to have as much a diagnosis of Munchausen’s Syndrome as somatization.

Previous posts on M.D.: Issue #1, Issue #2, Issue #3, and Issue #4.
Previous episodes of Flashback Week.

Tags: comics medicine m.d. amputation technology depression

Another example of the psychic nosebleed courtesy of Nate Gray, the eponymous “X-Man.” In this scene from X-Man #18, Nate is having a psychic battle with Mr. Sinister, and losing. The script is by Terry Kavanagh with pencils by Steve Skroce. This issue marks the beginning of the Onslaught storyline, at least in this title. To drive the point home, there is a feature in the back about Jim Lee’s redesign of the Fantastic Four (which was probably the least offensive of the Heroes Reborn comics, though I surprisingly enjoyed Iron Man as well — it’s the only time that I can remember liking Whilce Portacio’s art) All previous Psychic Nosebleed Zen posts Tags: comics medicine nosebleed nate grey

Scene from New X-Men #40. Script by Kyle and Yost. Art by Young.

In a hospital in Germany, Amanda Sefton (sorceress and Nightcrawler’s former girlfriend) has flatlined and is being defibrillated by X-Men wannabe Surge. I can spot two significant errors in this scene (plus a nit-pick or two), how many can you spot?

Need a hint? Just check out this helpful post from last summer.

(I guess we can add Surge to the list of super-heroes using their powers to defibrillate, a list that — so far — also contains Black Lightning and Iron Man.)

Previous picture quizzes

Tags: comics medicine new x-men picture quiz

Time to take a look at the list of best-selling book in the Marvel Universe:

Fiction
1. My Husband the Skrull
Judith thought she had the perfect marriage, but then the truth came out: not only was her husband seeing other people, he was other people.

2. How Green Was My Jury
In her third book, ace attorney Suzanne Grey takes on the Crass Corporation, accused of poisoning an entire town with toxic gamma radioactive waste.

3. Un-Registered Love
He was an vigilante who refused to register, she was the government agent designed to hunt him down. Could the love they once shared survive this tumultuous time?

4. Secret Agent Spencer: Death Wears a Cape
In his eighth book, the world’s top secret agent Blaze Spencer takes on a crazed serial killer who was once a teen-aged sidekick.

5. Superheroe$ Wive$
Being the wife of a famous super-hero isn’t all it’s cracked up to be, discovered Tess, the young wife of Mr. Patriot. She soon learned the sordid details of what really goes on behind closed doors at “team meetings.”

Non-Fiction
1. Iron Man’s Fascism is Fun Children’s Activity Book
Now in its 17th printing, this exciting coloring book allows children to understand why it is important to do everything the government asks without question.

2. The Champion’s Order’s Guide to Trademark Protection
Tired of your once protected trademarks expiring? This book will tell you how to keep trademarks forever and ever. Endorsed by Disney.

3. So Your Neighbor is an Un-Registered Vigilante
Learn how to turn in your neighbors, family, and friends for fund and profit. Sold in sets with The Field Guide to Registered Super-Heroes.

4. Doc Samson’s Guide to Cooking Lean and Staying Clean
Eat healthy and think healthy thanks to America’s favorite super-hero psychiatrist.

5. The Wit and Wisdom of Penance
Pamphlet. Large Print.

Having heroes turn into villains has only rarely been handled well. The payoffs — when it’ s done right — are memorable, but the ploy seems to fail (and usually fail spectacularly) far more often than it works. The most common explanations (amnesia, mind control, shape-shifter impersonation, mirror universe, vampire bite, evil clone) have never worked for me, it always seems superficial and not real.

Looking at my list, a few patterns emerge. A good hero/villain doesn’t necessarily need a good motivation (did Terra really have one besides money and disliking do-gooders?), but a bad motivation (trying to win an ex-husband back, for example) will kill any momentum. The revelation should come as a surprise, but there should be hints that all is not right if you go back and read the previous issues. Every hero is somebody’s favorite, so a hero-turned-villain, even handled well, is going to piss somebody off. Finally and most importantly, any hero/villain conversion as part of an event comic or mini-series is pretty much guaranteed to be bad.

(I’m not counting any villains turned heroes turned back to villains because that reversion to type seems inevitable. Magneto’s gone through the villain/hero/villain cycle at least 6 or 7 times alone. I’m also not counting Elseworlds or possible futures.)

Here’s my quick list of hero turned villains that have worked, or not worked for me (plus a few I’m not quite sure about). There may be some spoilers:

GOOD:
1. Terra from The New Teen Titans.
2. Dark Phoenix. I’m not counting the Black Queen aspect, as that falls under the mind control explanation I don’t care for, but Jean’s subsequent metamorphosis into Dark Phoenix was well done.
3. Runaways. (I don’t want to name names, since this is still a recent series.)

BAD:
1. Madeline Pryor
2. Monarch/Extant (Hawk)
3. Monarch (Captain Atom)
4. Alfred Pennyworth
5. Jean Loring
6. Maxwell Lord
7. Iron Man
8. Parallax
9. Triumph
10. Rusty, Skids

UNDECIDED:
1. Ozymandias in Watchmen. This never completely worked for me, mostly because I never had a good sense for who Ozymandias was, so why should the reveal be a surprise?
2. Atom Smasher.
3. Hulk. He’s coming back to take names and kick butt. But then, he’s been played as a villain many times before.

Tags: comics hero villain

This near perfect example of technobabble comes from Iron Man #14, in the scene where Iron Man is explaining to Spider-Man how he managed to override his spider-sense. Iron Man’s pronouncement sure sounds scientific until you break down what he’s actually saying and realize it makes no sense whatsoever.

“isolated its frequency” That almost makes sense — spider-sense may have a frequency — but then he goes and contradicts it with the rest of the sentence. Since when does smell have a frequency?

“neural net” Iron Man can build all the neural networks he wants — and they might even replicate Spider-Man’s spider-sense — but unless he manages to build one inside Spider-Man, it’s not going to work the way he wants it to.

“pheromone-based defenses” So Spider-Man essentially smells danger? He can smell a bullet being shot at him? Or a laser moving the speed of light? Maybe Iron Man’s just saying that Spider-Man smells horrible and no one wants to get near him.

Scene from Iron Man #14. Script by Daniel Knauf and Charles Knauf, pencils by Patrick Zircher

Tags: comics medicine technobabble iron man spider-man

SHIELD Scientist: We’re after the Homo habilis. We want the caveman.

SHIELD Scientist: The pre-man, regardless of his origin, is an evolutionary time capsule. He is from a time before cancer, before AIDS.

Homo habilis lived during the early Pleistocene, roughly 1.8 – 2.5 million years ago. It is entirely likely that they lived before AIDS (though there were probably equally nasty diseases back then). It is untrue to say that Homo habilis lived “before cancer”; they did not. The first documented evidence of cancer dates back to 300-350 million years ago, the time of the vertebrate fishes — long before the first dinosaurs appeared, let alone ancient man. The frequency of cancers seemed to increase as the number of land-dwelling vertebrates rose, and another increase in cancers occurs once humans* appeared on the scene. Overall, the incidence of cancer appears to be substantially lower in the prehistoric era than in the modern era. There are likely many reasons for this, including fewer environmental toxins, a shorter lifespan, poorer detection … and a significant selection bias (who is or isn’t likely to end up fossilized, which cancers do not show up in fossilized remains, etc. etc.).

*Admittedly, there have not been any cancers found in the Homo habilis skeletons available, but there aren’t a whole lot of them to begin with (and fossilized bones aren’t the easiest way to find cancers). The first documented “human” case of cancer dates to 1.5 million years ago (Homo erectus), but I think it would be foolish to believe that Homo habilis never experienced cancer when it had already been around for millions of years, since the first of the vertebrates.

Tags: comics medicine cancer heroes for hire homo habilis

We’re all well familiar with the fact that psychic powers can cause nosebleeds. But what else can lead to nosebleeds in comic books? Here are three of the top causes of comic book epistaxis:

Sonic Blasts	Drugs
Conan

Scenes from Stormwatch P.H.D. #6 (Gage, Mahnke), Iron Man: Hypervelocity #3 (Warren, Denham), and Conan #38 (Truman, Nord).

Tags: comics medicine nosebleed stormwatch iron man conan

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

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

Which of these are real drugs, and which are comic book drugs?

• Venox
• Gardasil
• Denyitol
• Timelozar
• Exubera
• UFOpium
• Valtrex
• Scapalamine
• Rocuronium
• DMN

JSA Classified #23 “Nightfall, part 1”
J.T. Krul, writer
Alex Sanchez, artist

It’s a good time to be a Dr. Mid-Nite fan. In addition to his regular appearances in the Justice Society of America and cameos in 52, he has had a starring role in 3 of the past 5 issues of JSA Classified. J.T. Krul, who I’m most familiar with from his work at Aspen, has turned in a strong story in this issue. It returns Dr. Mid-Nite to his roots in Portsmouth, and is more in the vein of a horror and detective story than his last appearance, which (also excellent) was more of a standard super-hero tale. Sanchez’s art is good and fits the noir mood well, except that I’m not a fan of how he draws Dr. Mid-Nite’s costume.

In terms of the medicine, Krul has done his research and it shows. Still, there are a couple of areas I’d like to discuss:

Detective: Big fella. Did he give you much trouble?
Dr. Mid-Nite: Nothing 150mgs of Ketamine couldn’t handle. He should be out for at least the next thirty minutes.

Ketamine is a rapidly acting anesthetic. It is used medicinally in people, but is probably more common nowadays in veterinary use. In lower doses, ketamine has dissociative and hallucinogenic properties and has an extensive history as a street and club drug.

For a generally safe, quick acting anesthetic, Ketamine is a good choice for Dr. Mid-Nite. However, a dose of 150mg is too low for a man of that size. That amount is reasonable (if not a little high) for recreational use (definitely not recommended!) but it wouldn’t be enough to produce the anesthesia shown in the comic. Assuming a 250 pound (114 kg) man, an anesthetic dose would start around 800mg. It should take effect in about 3-5 minutes, and as Dr. Mid-Nite states, lasts for 20-30 minutes. Ketamine is also Schedule III Controlled Substance in the US, so this is yet another example of Dr. Mid-Nite breaking Federal and state drug laws.

Dr. Mid-Nite: You really should consider limiting your blood intake. You could suffer an iron overdose or even develop toxic porphyria.

Porphyria is a condition where there is a breakdown in the synthesis of heme (one of the components of hemoglobin). Toxic levels of precursor chemicals build up and lead to a variety of symptoms including abdominal pain, vomiting, irregular heart rhythms, seizures, hallucinations, and paranoia. Skin rashes are common as well.

Porphyria is usually an inherited disease, but there have been cases where exposures to certain chemicals have caused the condition. This is the “toxic porphyria” Dr. Mid-Nite mentions. The most extensive case occurred in Turkey in the 1950s when grain made into flour was contaminated with hexachlorobenzene. Over a five year period, nearly 5000 people were affected.

I can find no connection between drinking blood and toxic porphyria in the medical literature. Biochemically, it really doesn’t make much sense either unless the blood is somehow contaminated. If ingestion of blood could cause toxic porphyria, then patients with gastrointestinal bleeding would develop the disease, but they don’t. Frankly, the only mentions I can find relating blood and toxic porphyria are on several fringe websites that discuss — and seem to recommend — drinking blood and mention as a side effect “(possibly) toxic porphyria”. It’s not hard to notice that every website has the identical paragraph about the risks of drinking blood so it’s likely they all cribbed it from the same place, and that place was wrong. I think it’s safe to label this one an urban legend.

On the other hand, a good case can be made that drinking blood could lead to iron overload. Most iron overload situations are due to hemochromatosis, a hereditary disease where the body cannot process iron properly. Even without hemochromatosis, it is still possible — though rare — to develop iron overload by taking in too much dietary iron. There is a condition known as “African Iron Overload” that occurs among certain African tribes who brew a drink high in iron. Individuals who imbibe large amounts of this beverage develop iron overload*. I would think that regular ingestion of blood would be a similar situation.

*There is some evidence that there may be a genetic disposition involved as well as drinking high-iron beer.

Tags: comics medicine dr mid-nite ketamine porphyria iron overload

With the Daytona 500 this weekend marking the beginning of the 2007 NASCAR season, I thought this would be a good time to look at the history of NASCAR and comic books. What’s the point of being a vocal comic book and NASCAR fan if I can’t put it to good use?

Contrary to popular belief, the National Association for Stock Car Auto Racing — better known as NASCAR — actually has a fairly substantial association with comic books — both as a subject and as a sponsor — starting in the early 1990s.

Beginning in 1991, Vortex Comics published a number of NASCAR-related comics. There was The Daytona 500 Story, which related the history of the race of the same name. Legends of NASCAR ran for 16 issues, and each issue featured the biography of a different racing champion. The art was surprisingly good with pencils by artists including Herb Trimpe and Don Heck. There was also a Legends of NASCAR Christmas Special — and, true to the spirit of comic books in the ’90s — a hologram cover. Vortex also published NASCAR Adventures which, like Legends of NASCAR, profiled a different racer in each issue. It originally ran for 2 issues, but then came back with a #5, and a little later with a #7. To the best of my knowledge there was never a #3, 4, or 6. For the kids, Vortex published the one-shot Adventures of the NASCUBS, featuring anthropomorphic race car driving animals as well as the “Official Mascots of NASCAR.” The NASCUB characters have never been seen again.

In 1998, at the UAW-GM Quality 500 at Charlotte Motor Speedway (now known as Lowe’s Motor Speedway), Dale Jarrett competed in a special Batman themed car. His teammate, the late Kenny Irwin, raced in a Joker car.

In 1999, DC released Superman Meets the Motorsports Champions, a one-shot comic book starring Superman (surprise!) as well as 9 different race drivers including Jeff Gordon and Dale Earnhardt Jr (back when he was driving exclusively in the Busch Series). The comic was written by Chuck Dixon with art by Paul Ryan and was available only at K-Mart stores. Later that year, Jeff Gordon raced a Superman themed car in the Winston (the NASCAR all-star race) and Dale Earnhardt Jr. raced another in the Phoenix 300.

In 2000, Custom Comics of America released RaceWarriors (probably not the best name for a comic), which purported to tell the story of stock car racing in the year 2020. Each issue also featured a backup feature on a famous NASCAR driver. It was an ambitious project, as the initial covers stated “A new edition each week” and “Collect all 38 issues!” Presumably, they were going to release a comic for each week of the racing season, including the off weeks. However, by issue #9 the blurb on the cover had changed to “A new edition every 2 weeks” and issue #10 had “A new edition ever month.” There was no issue #11.

In 2001, Bill Elliot (#9) and Casey Atwood (#19) both raced special Spider-Man themed cars at that year’s UAW-GM Quality 500 in Charlotte. Ironically, both of them were driving Dodges. These were the best looking Spider-Man cars by far, much better than the ones designed to advertise the Spider-Man films.

In April 2002, at the Texas Motorsports 300 (a Busch Series race), Lyndon Amick raced a Spider-Man/Dr. Pepper themed car to advertise the upcoming Spider-Man motion picture.

Terry Labonte had a special Spider-Man 2 theme on his #5 car during the 2004 Pepsi 400 in Daytona to advertise the second Spider-Man movie.

In August 2004, Hot Wheels sponsored a Justice League Racing Weekend at the Michigan International Speedway with several Justice League themed cars racing on both days. In the Busch Series race on August 21st, there were Flash, Batman, and Martian Manhunter cars. The next day, at the main Nextel Series event, there were Flash, Green Lantern, Batman, Superman, and Wonder Woman Cars. There was also a general “Justice League” car showing all the heroes. The villains weren’t left out either; they were featured on the pace car. Appropriately, Greg Biffle in the #16 Flash car won the race.

Not content with his name on just a few cars, Batman had an entire race named after him. The June 19, 2005 race at the Michigan International Speedway was officially known as the “Batman Begins 400.” Mark Martin also raced a Batman Begins themed car in the event.

In 2006, Jeff Gordon raced a Superman Returns car in the July 1st Pepsi 400 at the Daytona Motor Speedway.

This year the NASCAR/comic book connection continues. We have already had NASCAR featured in Archie #572, and later in the year comes the NASCAR Heroes series by NASCAR Comics.

Tags: comics nascar

To rescue his niece, John Henry Iron (Steel) and the Teen Titans break into Lexcorp and battle their way through Lex’s goons and the remaining members of Infinity Inc. until Steel confront Lex Luthor in his office:

Lex Luthor to Steel: You have four broken ribs and a ruptured appendix. Your small intestine is leaking fecal matter into your blood stream. Trust me–I have x-ray vision.

Let’s take a closer look at the injuries Lex claims that John Henry Irons has suffered:

broken ribs: Most likely suffered when he was being crushed by Everyman. Broken ribs are painful and will take several weeks to heal, but they are not usually dangerous. Rib fractures can be more serious if several ribs are broken in multiple places resulting in a flail chest, or if the broken ribs are pushed far out of place and are sharp enough to lacerate the lungs, but thankfully both of these injuries are very rare.

ruptured appendix: Most likely injured by the hammer through the abdomen. The appendix may not serve much of a function, but a ruptured one can lead to serious problems such as peritonitis. This will require surgical repair.

small intestine: An injured small intestine may leak intestinal contents into the abdomen, but not into the blood stream. The circulatory system has evolved in such a way that foreign matter doesn’t “leak” into it, even in a trauma situation. An injury leaking intestinal contents into the abdomen is serious and a surgical emergency. The intestinal contents have digestive enzymes that cause inflammation of the peritoneum, and bacteria which infect it. Surgery drainage and repair along with high-dose antibiotics are needed, and the sooner the better.
A nit-pick, but digested food in the intestine is “chyme” and doesn’t become “fecal matter” until well into the large intestine.

Lex is a shrewd businessman and a good scientist, but he’s not a doctor. His descriptions are off in places, and I suspect this is because he’s being his normal condescending self and trying to look like he knows more than he does — he ends up using the wrong terms and describing unlikely injuries. In fact, if you glance at the scene in question, he’s not even looking at Steel when he “diagnoses” him.

I wonder about how good x-ray vision really is. I know it’s been established that x-ray vision better than a regular medical x-ray, but those are some pretty specific injuries Lex is describing. I would need to order a CT scan with oral contrast to diagnose those. But then again, how much is the x-ray vision, and how much is Lex just gloating/bluffing?

Tags: comics medicine steel lex luthor flail chest peritonitis 52

This year, I’m going to start my annual recap of the year in comic book medicine with a look at the Worst Comic Book Medicine of 2006 because that’s the part everybody loves best anyway. This year, there were no comic books with horribly bad medicine, but there were still too many with medical mistakes.

Worst Depiction of Medicine:
Nothing this year was as astoundingly bad as the winners from the past two years, so I’m going to go with a soft call and award Renee Montoya’s Magic Cast from the high-profile 52 the “Worst Depiction of Medicine in 2006.“ Is it a short arm cast? Long-arm? Splint? Who knows — it changes from issue to issue (and panel to panel).
This year’s worst OR scene was in Friendly Neighborhood Spider-Man #3.

Worst Doctor:
Hush wins the award of worst doctor this year for his part in the Joker/pacemaker storyline in Batman: Gotham Knights #73-74.

Worst Single Medical or Scientific Concept:
Ultimate Spiderman #98, for revealing that chimpanzee DNA is closer to Peter Parker’s DNA than the DNA from his own clone.

Worst Imaginary Medicine or Treatment:
Spider-Woman’s breast implants. Well at least the truth is out there now.

Dishonorable Mentions:
For comics that went benarth beneath and below the call of duty, delivering scenes fraught with horrible medicine and science.

• Ex Machina #18-19, for confusing ricin wih sarin
• Batman Annual #25 for leaving Jason Todd’s stiches in for over a year.
• The use of lithium (the lithium used in rechargeable batteries) during an emergency resuscitation in Generation M #5
• The intentional stopping/starting of Crimson Dynamo’s heart in Iron Man #7.

Tomorrow, I’ll take a look at the Best of Comic Book Medicine over the past year.

Previous “Worst of the Year”: The Worst Comic Book Medicine of 2005 The Worst Comic Book Medicine of 2004

For a change of pace this week, I’m not going to look at medicine being used to heal people, but instead I’ll be looking at characters using medicine as an offensive weapon.

Remember Iron Man #7, where Iron Man uses his repulsor rays to purposefully stop the Crimson Dynamo’s heart? That’s a perfect example of offensive medicine in action (though as I pointed out in my review, it wouldn’t really have worked as well as Stark would have liked).

And if all goes as planned, we’ll end the week with a visit from everyone’s favorite Substitute Legionnaire, Drura Sehpt.

Tags: comics medicine iron man

At last! The event every fan had been clamoring for: the return of Titans West! Personally, I never really understood the mystique of Titans West as they appeared for all of two issues in the late ’70s version of the Teen Titans and consisted of mostly B-level heroes (excepting Hawk and Dove of course, and the post-Crisis version did ramp up the power level). Nevertheless, the first Hawk & Dove Annual features their “long-awaited return.” But that’s not all the surprises this issue contains as it also features a final guest star that really puts the machina in Deus Ex Machina. Overall, this is near perfect example of what an annual should be: a larger than life adventure that just wouldn’t fit in the regular title.

The story picks up shortly after Hawk & Dove #14-17. In that adventure, Hawk and Dove had chased their arch-foe Kestrel to his home dimension of Druspa Tau — a dimension that also happened to be the residence of T’Charr and Terataya, the Lord of Chaos and the Lord of Order that gave Hawk and Dove their powers. In the final scene of that story, Hawk and Dove absorbed the essences of their respective creators. This greatly increased their powers, but it also raised the question of whether or not Hawk and Dove also absorbed the love the two Lords felt for each other.

In the days since their return to Georgetown, Hank and Dawn have been avoiding each other and pretty much everybody else. Today though, their friend Donna has a big tennis match and they’ve promised her their support. Donna’s game is against one of the rising stars of the professional circuit: Bette Kane. Does that name ring a bell? It should. Debuting in Batman 139 in 1961, Betty Kane and was the original Bat-Girl (note the hyphen). After a brief time in the sun, she appeared only rarely — the last time with Titans West. After Crisis on Infinite Earths, she was ret-conned to Bette Kane and Flamebird.

Anyway, Bette trounces Donna. After game, Dawn returns home to find a mysterious envelope on her front step made out to Don Dove Dawn. Inside she finds a picture of the Titans West team and a note telling her that she needs to go to a certain hotel room across town. It also hints that father, a S.T.A.R. Labs scientist, may be in trouble. She knocks on the door and discovers that she’s at Bette’s hotel room and that Hank is already there (but not for the reason you think — and not the reason Bette would like — he just wanted someone to talk over the whole Don/Dawn thing). Hank and Bette realize that the note must be from their old teammate Lilith and that they must be needed at S.T.A.R. Labs.

Hawk, Dove, and Flamebird travel to S.T.A.R. Labs. It turns out that the scientists there have opened a portal to some mysterious dimension. The exploration team, as well as the rescue team that went in after them, have both disappeared. Flamebird calls up her old teammates Mal Duncan (once the hero Gabriel — an expert in dimensional travel) and Karen Duncan (Bumblebee — who is a S.T.A.R. scientist in her own right). They bring Chris King with them (who has somehow absorbed the abilities of the H-dial he used to wear and now becomes a different random superhero on the hour every hour) as well as a houseguest who has overstayed his welcome, Charlie Parker (Golden Eagle).

While Mal stays behind to monitor the portal, the rest of the new Titans West team (though you’ll notice they’re actually on the East coast) travel through the portal and find themselves in a barren, rocky landscape. Chris, as Synapse the Energy Man, tracks the homing device used by the rescue team. But it’s a trap! He and then the rest of the team are ambushed and defeated by a gang of villains including the Iron Major, El Papagayo, Icicle, Clayface II, the Top, and the Electrocutioner. Dove realizes that all these villains are dead, and the dimension they are in is some sort of purgatory. The villains take Bumblebee with them as a hostage as well as the homing device. They intend to use the S.T.A.R. Labs portal to return to the land of living and resume their life of crime. They figure they can force Bumblebee to open the portal, and the rest of the Titans won’t be a threat because they’re stranded miles away without the homing device to lead them back to the portal.

Mal Duncan and Lillith are waiting for the villains at the portal. Mal manages to defeat the Iron Major and rescue Bumblebee, but the Icicle takes Lillith hostage easily (maybe a little too easily). About this time, the remaining members of Titans West arrive on the scene riding on the back of the Haunted Tank. Yes, that Haunted Tank, along with the ghost of General J.E.B. Stuart (in a scene that has to be seen to be believed). The tank smashes Clayface with its gun and the Titans easily defeat the remaining villains — but Lillith is still a hostage. Using this to their advantage, the villains escape and have Lillith lead them to the portal — which they eagerly jump into. Of course, it isn’t the real portal, but a fake portal set up by Etrigan the Demon. In fact, this whole scenario was a trap set by the Demon, and he was the one holding the scientists and rescue team captive. All the villains are returned to Hell except the Icicle, who has repented his life of crime and actually helped Lilith trap the other villains. He is allowed to move on to “the mountains”, which is presumably Heaven. Hawk realizes that his brother Don must be there as well and wants to bring him back, but the ghost of J.E.B. Stuart makes him realize that while Don’s life may have been cut short, it was a fulfilling one. Hawk, Dove, and the remaining Titans West members return to the real world, bringing the missing scientists and rescue team with them.

All Previous Hawk and Dove Reviews

Tags: comics hawk dove titans west flamebird etrigan haunted tank

After the infamy of the 1950s Senate hearings on the comic book industry, EC abdandoned their traditional horror and true crime stories for a new public-friendly approach. One of EC’s new comics was M.D., a comic about doctors, told in the delicate art and typographic fonts common to classic EC comics.

M.D. #4 was published in October/November 1955 and contains four short comic stories, a one page text piece, and a letters page. The cover by Johnny Craig shows physicians resuscitating a drowning victim. Note the old-style approach to artificial respiration, with the patient laying face down and the doctor’s weight on the back of the patient’s chest and abdomen. This was the standard approach until mouth-to-mouth respiration was developed.

The first story, “So That Others May Walk”, concerns polio. Thanks to immunizations, polio is thing of the past in the developed parts of the world and we’ve forgotten how devastating this disease truly is. I think a copy of this story should be provided to everyone who questions the need for vaccinations.

Danny Hoyt has contracted polio and has been placed in an iron lung. His mother Francis is concerned that the doctor is treating her son as a number, and not a real person. Dr. Wolack tells her the story of Jimmy, a young boy who contracted polio just like Danny. Jimmy had to learn to breathe on his own again and then had to learn to walk. It was slow going, but Jimmy persevered. Even though he walks with a limp, he still made it a point to play sports. He studied hard and made it through high school as the valedictorian. He went on the college and then medical school. That’s right: in that hopeful twist that occurs in many medical stories, the boy Jimmy grew up to become Dr. Wolack, the physician treating Danny. Reassured, Danny’s mother thanks him and goes to spend time with her son.

Next is a one page text piece about Dr. William Harvey, the doctor who discovered the circulation of the blood. He was ostracized and considered a heretic for his views. He was even placed on trial. Charles the First remembered Dr. Harvey though, and when a French countess was bitten by a poisonous snake, he sent for him to treat her. Click here for the full fascinating tale.

The second story, “New Outlook”, tells the story of Marian, a college student who suffers extensive facial injuries in a car accident. She is horrified by her appearance, and locks herself away from her family and boyfriend. The plastic surgeons calmly work with her, and after more than a year and multiple surgeries, she regains her beautiful countenance and says yes when her boyfriend offers her his fraternity pin.

The third story, “Point of View”, is fairly disturbing. Donald Archer wakens in the hospital after a terrible car accident (yes, another one). He demands to know what happened to his daughter and wife. The doctor tells him that his daughter is fine, but that his wife has died from her injuries. The doctor then asks for permission to transplant his wife’s corneas into a blind patient. Donald refuses and orders the doctor out of his room for even suggesting such a thing. The doctor doesn’t give up and keeps talking to Donald about the need for the corneas but Donald remains adamant and refuses to give his permission. Finally, the doctor brings in an ophthalmologist who manages to talk Donald into donating his wife’s corneas. At the end of the story, when Donald finally gets the chance to visit his daughter, he discovers that she was the blind patient. The doctors needed his wife’s corneas to repair the eye damage his daughter suffered in the accident — though you think it would have gone smoother if they told him who the blind patient was from the beginning.

“Worried Sick”, the final story, is an unusually downbeat story — in an O. Henry kind of way — for this comic. The story concerns a man with a stress induced ulcer. He is an up and coming grocer, but that’s not enough for his wife. She keeps pushing him to expand his business, and he does — time and time again — until he is the top grocer in the city. He doesn’t see any money though, because his wife keeps spending it. He sees the doctor about some stomach pain he’s been having, and the doctor informs him that his has an ulcer and puts him on a special diet. The grocer explains things to his wife, and she promises to cut her spending, but she keeps throwing expensive parties and he ends up requiring surgery for a perforated ulcer. This time, the doctor speaks to the wife himself and explains how the stress from her spending is causing her husband’s ulcer. She promises to restrain her spending. All seems well until her husband returns home from the hospital and finds his wife and thrown him a get well party – and told the caterer to bring the best food money can buy. The look on her poor husband’s face is priceless.

Like previous issues, M.D. #4 contains interesting glimpses of state of the art medicine from a half-century ago. It also contains some not-so-subtle sexism, but I’m afraid that’s standard issue for most of these classic medical comics.

Tags: comics medicine m.d. polio iron lung ulcer william harvey

1. Death is Rare

“Well Jimmy, you’ve fallen off a twenty story building into the path of a speeding bullet train which ran you over and knocked you down a hillside of broken glass into a shark tank, where you were bitten by several great white sharks but you managed to climb out by grabbing a wire — which happened to be a downed live wire — the shock of which catapulted you into the hot tar a road crew was spreading on the street. They rescued you, but not before you were run over, twice, by the steamroller. So how do you feel.”

“A little winded, but not bad, doc.”

2. Medication takes effect immediately
None of this real world timing, where antibiotics will take about twenty-four hours to start working, and injections take fifteen minutes.

“This alien virus has got me beat — I’ve got double vision, acne, nausea, muscle aches, and a fever of 104° F” {pops pill} “Aha! All better! Now to continue my fight for justice!”

3. There’s always a doctor around when you need one.
Every team, from the multiple X-teams to the smallest band of pirates, seems to have their own doctor or medical professional. Looking back over the Avengers roster and they’ve had what — three or four doctors on the team over the years? Heck, even the Defenders managed to have a doctor on the team. And even if your team doesn’t have a doctor, your neighborhood family doctor can always make a house call (at least in the Marvel Universe).

4. Plastic Surgery is Perfect
The only people who have scars are those who need them to look either A) menacing, or B) pitiful. Comic books tell us that a good surgeon can make anybody look exactly like anybody else. Not to mention that they can repair Harvey Dent’s horribly acid scarred face to look exactly like it did before, several times (now ask yourself, where are they getting the skin to repair Harvey’s face?).

5. No Insurance Hassles or other Red Tape

“I’m sorry Mr. Man — I mean Iron Man — but your insurance specifically required you to pay a $5 co-pay before you can be seen for any medical services. I realize it’s hard to carry around spare cash in that outfit, but the rules are the rules.”

Your doctor has given you this information sheet because you have been diagnosed with Metal Eating Disease (M.E.D.). This rare disorder is caused by an infected bite from metal-eating aliens. It most commonly affects young red-headed cub reporters, though anyone who routinely encounters metal eating aliens may also be at risk.

It is best just to let the disease run its course. For the next forty-eight hours, avoid going anywhere that metal may be present. Do not drive your car. Stay away from electical devices. Do not carry large amounts of change. Do not read Iron Man. Avoid vending machines. Despite its name, Heavy Metal music continues to be safe to listen to.

Please note that while Metal Eating Disease is not fatal to you, it may be fatal to your social life:

It is best to completely avoid the dating scene until after the Metal Eating Disease has run its course.

Sadly, modern medicine has developed no cure for Metal Eating Disease.

Though there is no treatment for Metal Eating Disease, the disorder is self-limited and will resolve on its own in two days. In just forty-eight hours you’ll be as good as new…though please remember that you’ll set off airport metal detectors for the better part of a week, and don’t try to swim until the all the metal has passed through your system.

Images courtesy of Superman’s Pal, Jimmy Olsen#68. Script by Leo Dorfman and art by John Forte.

Tags: comics medicine jimmy olsen superman disease

I think the majority of the medical errors I notice in comic books can be ascribed to the writer. However, because the storylines are so varied, it is unusual to see the same mistake repeated again and again and again. Still, there are certain themes that crop up frequently:

1. Germs Bacteria and viruses are two completely different kinds of organisms and the words are not interchangeable. Notable bad examples: Grant Morrison’s first Animal Man storyline (Anthrax is not a virus) and Geoff John’s Avengers Red Zone storyline (Necrotizing fasciitis is a bacterial disease, not a viral one). And they’re not plants either, so don’t pull that white-kryptonite-will-kill-the-virus nonsense. Notable bad example: Action Comics #363-366 (The Virus X saga)

2. Antibiotics Really a corollary of the first rule. Antibiotics kill bacteria, they do not kill viruses. Antivirals kill viruses. If you want a general term that encompasses both, use the word “antimicrobial.” Notable bad examples: In at least one Batbook, they refer to treating the Clench virus with Streptomycin, an antibiotic. In Elektra, news reports mention that an emerging strain of Influenza (a virus) is resistant to all penicillins (antibiotics).

3. You Cannot Shock A Flatline When the heart goes into asystole (a term for when it stops beating and has no electrical activity), the treatment is NOT defibrillation. To restart a non-beating heart, the recommended treatments are CPR, epinephrine, atropine, and transcutaneous pacing. Defibrillation does more harm than good. Notable bad examples: Iron Man #7, Action Comics #817, Superman #175, X-treme X-Men #18, and a certain superhero movie in theaters now.

4. Bad Radiology One of the trickier aspects of medicine to learn is which radiology study to order when. For certain situations, an x-ray is best. For others, a CT scan or MRI is betters. Sometimes, a less common test such as a myelogram or PET scan may be the right choice. Writers will often choose the incorrect test for the situation, and their most common choice seems to be the plain old x-ray. It’s certainly understandable that a layperson would call everything an “x-ray”, but don’t put those words in the mouths of doctors, who would certainly know better. Notable bad examples: Mutopia X #5, Phantom #1408, Amazing Spider-Man #3, Strange Tales #115. Sometimes the artist is to blame, drawing x-rays or other films that are anatomically impossible, or are far from realistic. Notable bad example: Batman: Legends of the Dark Knight #192

5. Autopsies I simply can’t think of a remotely realistic autopsy scene in comic books. It’s either impossible things being discovered, blatantly obvious things being missed, untrained people participating, “heroes” walking off with some of the key body tissues, or just poor technique in general. Notable bad examples: Identity Crisis #2, Identity Crisis #6, JSA #67, 52 #3, Aquaman #30, Batman: Gotham Knights #73, and other Batbooks.

I recently won a set of auctions for several hundred comics of the ’80s and ’90s. At what amounted to 20¢ an issue (with shipping), I was able to acquire a bunch of comic series and specials that I had thought about owning, but never had the time to seriously track down, or never wanted to spend that much money on. I’m about halfway through the stack now, and here are my thoughts so far:

Air Boy
Loosely based on the Goldenn Age Airboy (the new Airboy was his son). The supporting cast was great (Iron Ace, Valkyrie, Sky Wolf, the Heap), but I found most of the stories to be rather lackluster, particularly the later ones. I think the main problem was that the title character was so dull and bland. Writer Chuck Dixon didn’t seem to know which direction to go with the character and what sort of stories to tell, a fact admitted in the final issue.

American Flagg (both volumes)
The prototypical Chaykin-man: square jawed, follows his own set of ethics, likes the ladies. The Chaykin penned and drawn stories were great. When other writers tackled the character, it wasn’t nearly as enjoyable. While some of the non-Chaykin stories are quite good, nobody else seemed to have as much of a handle on the character. As far as I know, this is the first series to feature a main character (or at least major supporting character) with diabetes.

The Atlantis Chronicles
A history of DC Comic’s Atlantis, as told by Peter David and Esteban Maroto. The idea of having the official Atlantean chronicler as the narrator is a clever idea and bridges the issues well. The story starts out good, but seems rushed at the end. I think too much time was spent in the founding of the underwater cities, and the later stories suffered for it. The art is spectacular.

Hammerlocke
A nine-issue science fiction mini-series by DC Comics. I would love to see this reprinted on some high quality paper as the Chris Sprouse art is wonderful, but gets lost and muddy on the cheaper paper. It’s well done, but not quite what I was expecting. The story is fascinating and there are some good characters, but it could have used about three more issues or tighter storytelling.

Lois Lane
A very heavy-handed not-very-enjoyable morality tale. And did I mention it’s a two-double-sized-issues heavy-handed not-very-enjoyable morality tale. Has one of the most shocking and bizarre forgotten bits of continuity since Peter Parker’s childhood abuse was mentioned and then abandones in the Spider-Man/Power Pack special. Look for it in a PSA Monday post soon.

Metropolis S.C.U.
An enjoyable four issue mini-series starring (among others) Maggie Sawyer and everyone’s favoritebisected villain Terra-Man. Contains one of the most naturally written gay relationship storylines I have seen in a mainstream comic. Still I wonder about the name: If it’s Metropolis S.C.U., what are they doing jaunting all around the country and the world solving crimes?

Rocket Racoon
Classic Bill Mantlo and Mike Mignola craziness. Four issues was probably one issue too long, though.

Deadshot (first series)
Very well done, but then what would you expect from John Ostrander, Kim Yale, and Luke McDonnell? They set up a good mystery and keep you guessing until the end, though once you know who the mastermind is, the parts all fall into place.

Captain Atom
Extremely enjoyable. Probably the most readable and consistent translation of the prior Charlton characters. The first fifty issues in particular, written by Cary Bates, are well worth tracking down.

Impulse: Bart Saves the Universe
Fun, but I was expecting a little more craziness. Writer Christopher Priest has the speed power down well (but not as well as Waid did in the destined-to-be-a-classic Impulse #3, but misses the best part of Impulse…the impulsivity, the lack of post hoc ergo proctor hoc that makes bart so Bart (or did until Geoff Johns sadly adultified him in Teen Titans).

Fury/Black Widow: Death Duty
Prestige format blah!

Iron Man #7 “Execute Program, Part 1”
Daniel and Charles Knauf, writers
Patrick Zircher, penciler

In the heat of battle, Iron Man blasts the Dynamo with his repulsor rays right in the chest and the Dynamo falls to the ground, his heart stopped. Iron Man flies down next to him and sends several jolts of electricity through the Dynamo suit, restarting his heart. After the battle, we discover that this stopping/restarting the heart is precisely what Tony Stark planned on happening.

I’m of two minds about the medicine here, and both of them think it’s wrong. First, a shot to the chest would not stop the heart as abruptly as it was shown in the comic. Second, even if it did stop the heart, Iron Man’s shocking the Dynamo to restart it was a bad idea.

• It is a known fact that a strong blunt trauma blow to the chest can cause a fatal arrhythmia (bad heart rhythm). However, in these situations the heart doesn’t stop abruptly — as happens to Crimson Dynamo — but instead develops a dangerous rhythm such as ventricular fibrillation that then deteriorates into asystole (the absence of a heart beat). The heart would not have stopped beating as completely and as quickly as shown¹.
• When the heart has stopped beating entirely, despite what you see on television, the chances of successfully restarting it are dismal. The recommended treatments include CPR, epinephrine, atropine, and transcutaneous pacing. You’ll notice that defibrillation (shocking the patient) is nowhere on the list². It is not a recommended treatment for asystole because studies have shown that it leads to even worse than expected outcomes (in other words, it leads to more dead patients).

I’ll admit that stopping an opponent’s heart is a novel, if fairly unethical, approach to battling super villains. But I would recommend that Tony Stark do a little more research into the physiology of the human heart before attempting it again³.

---

¹Unless, of course, Stark has developed some new Ultra-Repulsor-Heart-Stopper beams.
²Unless, of course, Stark has developed some new Ultra-Heart-Restarter-Shock gloves.
³Unless, of course, Stark has developed some new Ultra-”We-Never-Lose”-Manslaughter attorneys.

Tags: comics medicine iron man blunt trauma asystole defibrillation

It’s been a year since I took my last look at pregnancy in comics so I think it’s time to take an updated look. In the past few months alone, Selina had her baby, and unlike Jessica Jones, managed to have a pregnancy of less than a year (how long was Jessica pregnant anyway, 2 or 3 years?). As always, comments, corrections, and suggestions are appreciated. Thanks to everyone who has contributed in past years.

Heroes:
ADAM STRANGE
1. Alanna dies during childbirth.

ANIMAL MAN
1. Annie was pregnant and gave birth in the last issues of the series.

AQUAMAN
1. Dolphin and Garth (Tempest) had a son, Cerridan.
2. Mera’s pregnancy happened “off camera.
3. In the Atlantis Chronicles: Cora was raped by her cousin Dardanus and gave birth to Kordax (pregnancy not shown). Also Atlanna had a tryst with her ancestor Atlan and gave birth to Orin (Aquaman). This pregnancy was shown.

AVENGERS
1. Ms. Marvel was pregnant*
2. Scarlet Witch’s pregnancy was shown in the Scarlet Witch and the Vision mini-series, though her twins were later ret-conned out of existence. This led her to become murderously insane and then crossover-miniseries-murderously insane**. Apparently, the children have now shown up as characters in Young Avengers.
3. Jessica Jones was pregnant for what seems like years, and delivered a healthy baby.

BATMAN COMICS
1. Spoiler was pregnant and gave her child up for adoption in Robin; she later died during Wargames.
2. Francine (Man-Bat’s wife) was pregnant in the Batman titles in the 1970s and gave birth in Batman Family #17.
3. Batman and Talia had a son in the more-or-less non-canon Son of the Demon (though the pregnancy was pretty much “off screen”

CATWOMAN:
1. Selina gave birth in the first “One Year Later” issue of Catwoman. The pregnancy has not been shown (it was in that one year time gap) and the identity of the father is unclear at this point.

FALLEN ANGEL
1. Lee conceived a child with Juris. She let him think that she had miscarried after a fight with Boxer, but instead handed her son over to a nun.

FANTASTIC FOUR
1. Sue Richards had Franklin, and then lost her second pregnancy. A magical/time-stream induced third pregnancy gave the Richards a daughter, Valeria.
2. Lyja Storm was pregnant and gave birth to an egg.
3. Crystal and Pietro (Quicksilver) have a daughter Luna. Reed Richards (apparently an obstetrician in his spare time) delivered the baby.

FLASH
1. Iris was pregnant with twins at the time that the silver age Flash (Barry Allen) died.
2. Linda West lost twins due to an attack by Zoom. There was some question as to whether she would be able to become pregnant again. However, after another melee involving the timestream, Linda suddenly found herself very pregnant (from 0 – 9 months in seconds) and delivered a healthy set of twins.

HARBINGERS:
1. Kris Hathaway was pregnant and gave birth to the child who would be sent to the future to become Magnus, Robot Fighter.

INCREDIBLE HULK
1. Betty Banner was pregnant, but miscarried.

IRON MAN
1. Pepper Potts was pregnant, but miscarried.

JLA
1. Sue Dibny was pregnant when she was killedin Identity Crisis #1

JSA
1. Hawkgirl was pregnant as a teenager and gave the child up for adoption.
2. Dove was raped by Hank Hall (Hawk) and later gave birth to a child who ultimately ended up housing the soul of the new Dr. Fate, Hector Hall.
3. Power Girl was mystically impregnated by her grandfather Arion so she could give birth to the prophesied demon fighter Equinox.

INFINITY INC.
1. Hippolyta Hall was pregnant a long time, and ultimately gave birth to Daniel (who was taken from her by Morpheus to become the new Sandman).

KILLRAVEN
1. Carmilla Frost discovered she was pregnant in the Killraven graphic novel.

LOSH (1)
1. Garth Ranzz (Lightning Lad) and Irma Ranz (Saturn Girl) had twins. (Twins are the usual on Garth’s home planet of Winath; however, twins are determined maternally and Irma come from Titan. Plus are the twins fraternal or identical? Both have been shown on Winath in the series.)

LOSH (2)
1. In the “five years later” Legion, Night Girl was not only married to Cosmic Boy, but also pregnant.
2. Laurel Gand had a child by Rond Vidar.
3. The Ranzzs had a second set of twins during the five year gap.

LOSH (3)
1. Apparition (Tinya Wazzo) and Ultra Boy (Jo Nah) have married and had a child (Cub).

L.E.G.I.O.N.
1. Stealth had a child by Vril Dox.

MANHUNTER
1. Kate Spencer miscarried after a fight. She had not been aware she was pregnant.

MIRACLEMAN
1. Liz Moran gave birth in Miracleman #9.

MR. MIRACLE
1. Beautiful Dreamer was pregnant and gave birth.

NOBLE FAMILY
1. Zephyr became pregnant after a spiteful “night of passion” with her family’s greatest enemy. She delivered a healthy child, but it was stolen and she informed that her child had been stillborn.

SABRE
1. Melissa Siren was pregnant and gave birth in Sabre.

SQUADRON SUPREME:
1. Arcanna Jones was pregnant for most of the limited series, and gave birth sucessfully.

STARMAN
1. Jack fathered children with the Mist (see below) and his significant other, Sadie.

SPIDER-MAN
1. Mary Jane was pregnant but miscarried when one of Norman Osborne’s flunkies poisoned her before she gave birth (there is some debate online about whether she actually miscarried or the baby was stolen by Osborn).
2. Gwen Stacy had twins after an ill-advised tryst with Spider-Man’s greatest enemy: Norman Osborn (the Green Goblin).
3. In the Spider-Girl universe, Mary Jane’s second pregnancy was shown in detail.

TEAM TITANS
1. Donna Troy was pregnant at the beginning of this series. Her husband and child died in a car accident, and then she died in Graduation Day. She came back (again), but has yet to mention her family.
2. Mirage was pregnant at the end of the series and has since been shown with her infant daughter Julianna (Refresh my memory: was the father of Julianna the evil future Nightwing? And was it consensual?).

X-MEN
1. Madelynne Prior was pregnant with Scott Summer’s child (and gave birth to him) in the Uncanny X-Men. This child later went on through a very convoluted storyline to become Cable.
2. Wolverine left a pregnant lover behind in the Savage Land in the one-shot Wolverine: The Jungle Adventure (though it’s not 100% certain that he’s the father).
3. According to one of the tales in Classic X-Men, Colossus also fathered a child during a visit to the Savage Land (pregnancy off camera).
4. Angel Salvadore and Beak had a brood of flying beaked kids. Angel laid eggs, so I’m not sure you would necessarily call her pregnant.

Villains:
Punch & Jewlee
1. During their time inSuicide Squad, Jewlee suffered morning sickness and discovered she was pregnant. She and Punchh left the team soon thereafter and the pregnancy and delivery were “off camera.” They later showed up in Hawk & Dove toting a toddler.

Chesire
1. Gave birth to Lian, fathered by Speedy/Arsenal (Roy Harper). The pregnany was entirely off-camera, and Roy didn’t know he was a father until well after the fact.
2. She seduced Thomas Blake (Cat Man) in Villains United, allegedly for him to father a child for her.

Mist
1. Had a child by Jack (Starman). Pregnancy was entirely off camera.

Star-Sapphire
1. Raped by Predator (another of Carol Fenris’s alternate personalities) and impregnated in Green Lantern #43. Gave birth sometime during Extreme Justice.

Non-Super-Hero:
FABLES: Snow White became pregnant after a drug-induced night with Bigby. She later gave birth to a litter of wolf/human hybrids.

Y: THE LAST MAN:
1. Beth is pregnant with Yorrick’s daughter (note that this is not fiancee Beth, but another one)
2. The female astronaut conceived a child with one of her fellow astronauts and has delivered a healthy son

HELLBLAZER:
John Constantine’s birth was shown in detail, including the death of his mother and twin.

LUCIFER:
Jill Presto is mystically impregnanted by a magic deck of cards.

SWAMP THING:
Swamp thing used the body of John Constantine to father a child on Abby, unaware that John was tained with demon’s blood. Abby ultimately gave birth to Tefe. Not sure if pregnancy was “on camera” or not.

STRANGERS in PARADISE:
Francine miscarried.

ELFQUEST is chock-full of pregnancies and births. I’m not conversant enough with the series to comment.

Characters UNABLE to become Pregnant:
1. Black Canary – Sustained tortue injuries in Green Arrow: Longbow Hunters that rendered her sterile. Her recent dip in a Lazarus pit may have reversed this.

2. Firestar – Using her powers will cause her to become sterile. Hank Pym developed a costume for her that repairs the damage.

*Explanation per Matt Rossi: “Ms. Marvel was impregnated originally by Immortus’ son, who used the devices of Limbo to draw her to him, make her fall in love with him, and then implanted himself into her via some freaky Limbo technology. She then was sent back to Avengers mansion where she gave birth in an extremely short amount of time and the baby was Marcus, Immortus’ son (the one who impregnated her, remember) and then the baby, too, grew up rather remarkably quickly while time itself went ape because Marcus, concieved and born in Limbo, was a being out of time and his mere presence, not to mention the twisted nature of his self-conception into our world and the rapid time displacement, was shattering causality. Eventually Marcus agreed to go back to Limbo but pledged his love for Ms Marvel and asked her to come with him to Limbo, which she agreed to do and the Avengers let her (this was later pointed out to have been a really dumb move.) …I’ve simplified this immensely.”

**Explanation per Chris Arndt: “At first they were magically concieved from the Vision and Scarlet Witch’s love. I mean, how else could they do it? The Vision may be a synthezoid, but I bet he lacks swimmers. Heck, in Avengers West Coast, John Byrne revealed that the Vision didn’t even have external equipment, so to speak. Anyway, eventually it was revealed that the kids souls were re-allocated chunks of the major WCA villain at the time, Master Pandemonium. Mephisto stole his soul, broke it in five chunks, and Scarlet Witch accidentily made off with two of them when she started concieving babies; turns out creating life was beyond her; she still housed souls but later the housing disappeared when her thoughts were not specifically on her children. Raw deal. Her memories of the kids were erased to remove the trauma. All in all it turned out to be a good story but definitely something too dark for an all-ages comic. The worst part is that it was part of Byrne’s de-construction of the Scarlet Witch. She made up her children; she forgot her children; most readers assumed that the Vision was anatomically on-model and as Star Trek’s Data puts it “fully functional” and then Byrne revealed that the synthezoid lacked a male member (and based on dialogue the sudden absence wasn’t a noticeable change) which would essentially de-humanize the character to the greatest degree and thus make the Scarlet Witch the sickest she’s ever appeared to her fans. You can fool a legion of nerds, geeks, sci-fi fans, and whatnot into thinking she married a man if they’re given the impression that the Vision is a man but for his origins. It’’s harder to achieve the idea that she married anything but a robot, something with a life value or even a sexual value equevalent “to a toaster oven” when the robot in question has no Mr. Happy!”

Tags: comics medicine pregnancy

An underwhelming episode of House this week. There are spoilers below, but not the “big one” (is he or isn’t he?) so you can still watch the episode. (Feel free to mention it in the comments though, as it is an interesting situation.)

I didn’t particularly care for this episode of House. The main plot — House’s old friend and whether or not he was the girl’s father — did little for me. The medicine was uninspired as well. The team just lurched along from diagnosis to diagnosis with little reason, like a drunk stumbling down the street. That’s not to say the episode didn’t have its charming moments. The sperm donor scenes with Cuddy were good and seeing Wilson jealous over the fact that House actually has another friend was quite enjoyable.

Let’s start at the beginning: Crandall, one of House’s old friends, is flying on a plane with Leona, a teenage girl who claims to be his daughter. She was a victim of hurricane Katrina and has basically been living on the streets until recently. On the plane, she suffers a sudden intense hallucination and then collapses.

House and the team are called in to assess Leona. They are told that she has suffered cardiogenic shock (but it’s never explained how this conclusion was reached), but that it was not caused by a heart attack. The ER also managed to rule out toxins, infections, and Wolff-Parkinson White (a heart condition that can lead to a potentially dangerous heart rhythm). The team settles on the diagnosis of an arrhythmia. Leona must have experienced a bad heart rhythm which led to her hallucinations as well as her collapse.

An electrophysiology study (which looks at the electrical conduction within the heart) is performed and they find a spot in Leona’s heart that induces both an arrhythmia and a hallucination. The abnormal area of the heart is frozen to prevent the arrhythmia from recurring and the team believes that they’ve solved her problem. However, we know better as it’s only twenty minutes past the hour.

Despite the treatment, Leona suffers another hallucination. House wonders if it might be an atypical seizure or post-traumatic stress disorder. Then he decides that it must be an autoimmune disease that is causing her to interpret pain as hallucinations. The team straps her into a PET scan machine and House hurts her until she has a hallucination. He is now absolutely convinced that she must have a bad autoimmune disorder. Never mind which one, just know that it’s really bad! And it needs treatment now! Not the normal treatments like steroids or immune suppressants but instead she must have a bone marrow transplant at this instant! Anyway, as she’s undergoing radiation therapy to burn out her bone marrow so she can receive a transplant, House notices a black slime oozing from her mouth. It turns out that this is a combination of feces and partially-digested blood. This means that Leona has some gastrointestinal bleeding as well as a lower intestinal blockage which is causing things to “back up.”

House and team immediately decide that this means Leona has liver failure and she needs an immediate liver biopsy. Just as Chase is ready to perform the biopsy, House tells him to stop. Leona’s grandfather was a great jazz pianist and House has been in his office listening to one of his old jazz sessions. From this recording, House is able to determine that her grandfather had mental problems, hearing damage, and a history of liver disease. Putting this together with Leona’s presentation, House and Cameron deduce that Leona has hemochromatosis, and inherited form of iron overload. She is started on deferoxamine, an intravenous medication that removes excess iron from the body. Strangely, this treatment causes severe lung damage and Leona is placed on a ventilator. The team suspects the iron must be combining with something in her lungs to cause problems; they consider bacterial infections and neurodegenerative diseases, but then settle on fungus. First they suspect Aspergillus, but it doesn’t respond to therapy, so they realize that it must be a different fungus and finally diagnose Zygomycosis. Some IV therapy with Amphotericin B and Leona is ready to start her new life with her “father.”

The criticism: Medically, the arrhythmia diagnosis makes good sense, though the hallucination aspect is reaching. But to jump from that to a super-severe yet vague “autoimmune disorder” makes no sense. (I suspect the writers know this too as they never name the disease and just leave it vague). And then even if it is an autoimmune disorder, why jump to bone marrow transplant, an unproven (though apparently promising) treatment? The risks/benefit ratio is just too high. Now suddenly we’re told that it’s liver failure. Gastrointestinal bleeding and blockage could be due to many other conditions and Leona’s shown no other signs of liver failure. How about at least running some blood tests or an abdominal CT before a biopsy? Now the diagnosis is hemochromatosis. This one is at least logical, and diagnosing it through her dead grandfather is clever. But suddenly the treatment causes lung damage. Notice how the writers tried to pull this off: When deferoxamine is first introduced we’re told (correctly) that it is processed through her kidneys. Later, when the script demands, Chase reminds House that it is processed through “waste” (his vague term) and House then mentions that her waste system is messed up. No, her liver is messed up — her kidneys are still fine, and this bad plot-convention medicine hurts my head.

A few nitpicks too: Why is Chase performing the electrophysiology study? That takes a specially trained cardiologist. Why is Leona wearing EEG leads on her head the entire episode? Phlebotomy (repeat blood draws) is the recommended treatment for hemochromatosis, not deferoxamine. Deferoxamine is only used in very rare instances (when phlebotomy is not feasible or there is severe heart disease). If the team had used Amphotericin B for the Aspergillus — which is the recommended first line treatment — they would’ve covered the Zygomycosis too. And finally, Cuddy needs subcutaneous shots, not intramuscular ones, at this stage in IVF.

This episode gets a C for the mystery (just average) and a B+ for the final solution. The medicine earns a C-, below average and just plain wrong in several places. The soap opera aspect (at least the scenes with Cuddy and Wilson) redeemed the storyline somewhat and earned a strong B+.

• The previous House review
• A list of all prior House reviews

Still want more great medical reading? This week’s Grand Rounds — the best medical blogging of the past week — are being hosted by Dr. ibear over at Doc Around the Clock. As usual, there’s an incredible amount of fascinating reading. And did I mention the art?

Tags: television medicine house hemochromatosis aspergillosis liver failure zygomycosis grand rounds

A very somber (but sadly, not sober) episode this week. As usual, there are significant spoilers for this week’s episode of House ahead, so don’t come crying to me claiming nobody warned you.

A husband returns home to find his wife Kara have a seizure in the bathtub and their four-week old son Mikey drowning. By the time they reach the hospital, Mikey has resumed breathing and Kara has stopped seizing. Mikey is taken to the neonatal intensive care unit (NICU), where Chase happens to be working. Kara’s case is tackled by House, Cameron, and Foreman. Her calcium is elevated, and the initial concerns are hyperparathyroidism, cancer, and a “calcium-mediated neurotoxicity” — but apparently all those were ruled out in the ER. The next diagnoses considered include polyarteritis nodosa (a rare inflammation of blood vessels), Whipple’s disease (a rare type of bowel infection), a Strep infection, and vasoconstriction (a sudden narrowing of important arteries). The Strep test is negative, and when she is undergoing angiography, Kara suffers some sort of massive muscle contraction/seizure.

Meanwhile, Mikey’s oxygen levels suddenly drop. Chase listens to his lungs and diagnoses a collapsed lung (pneumothorax). He performs a needle thoracostomy and then acquires x-rays. He thinks the x-rays show a chemical pneumonitis (an inflammation of the lungs caused by an inhaled — or swallowed — irritant), but House disagrees and thinks the x-rays look like a bacterial pneumonia. He suggests placing Mikey on antibiotics and ECMO. Chase decides that House must be correct and starts the antibiotics and ECMO (extracorporeal membrane oxygenation — a big machine that oxygenates the blood and removes carbon dioxide).

In terms of Kara, the doctors are now considering a lithium toxicity and a myelogenous meningitis (a rare complication of leukemia where the cancer cells invade the lining of the brain). An MRI shows no brain tumor, but it does show a subarachnoid hemorrhage. It turns out that Kara has a bleeding disorder and her blood is not clotting as well as it should. Foreman’s search of Kara’s apartment turned up no lithium, but it did show a hidden bottle of vodka. When the team discovers that Kara is a former alcoholic, House suspects that she started drinking again and is now suffering from delirium tremens (a dangerous form of alcohol withdrawal). The liver damage from the alcohol would cause her bleeding problem (though they never seemed to run any liver tests). Foreman thinks it may be a conversion disorder, basically her body is having seizures to cope with the severe stress in her life. House overrules him and they place Kara in a phenobarbital coma to essentially sleep off her delirium tremens.

Kara’s feeling better when she awakens from her coma, and she is delighted to see her son (who appears fully recovered) and her husband. A short time later, House discovers her trying to suffocate Mikey. Chase resuscitates the baby and rushes him back to NICU. The team is now concerned that Kara has postpartum psychosis, especially after she admits that she hears voices telling her to kill her son. To ensure there is not some other neurological condition going on as well, they attempt to cause a seizure in her with sleep deprivation and strobe lights. Ultimately they succeed in setting off an atypical seizure that causes them to think that Kara is suffering from some sort of progressivedelirium. The possible diagnoses at this time includes Wernicke’s Encephalopathy (neurological disease caused by a severe thiamine deficiency – common in alcoholics), lithium toxicity, Whipple’s Disease, and pellagra (neurological disease caused by a severe niacin deficiency). Pellagra is the best fit, so they start her on niacin supplementation.

In the NICU, Mikey is not doing well. The lack of oxygen has severely damaged his kidneys and he has developed hyperkalemia (high potassium). Chase tries medication to bring the potassium level back to normal but it doesn’t work, and Mikey suffers a fatal arrhythmia (an abnormal heart rhythm — ventricular fibrillation in this case).

Kara is not improving despite the niacin, and complains of stomach pain shortly before vomiting blood. House has an idea but needs an intestinal biopsy. Because he suspects a disease that has a genetic component (and because Mikey has been breastfeeding and essentially eating the same food as mom), he can test the baby. A post-mortem examination of Mikey’s intestine reveals celiac disease, an autoimmune disease tied to eating food with gluten (wheat protein). This has caused malabsorption of vitamins (niacin, leading to pellagra and vitamin K, leading to a clotting disorder) as well as led to the development of a stomach cancer.

As the episode ends, both Kara and her husband are trying to come to terms with their son’s death — and having a hard time of it. Foreman is struggling to regain the skills he lost, and did I mention that Cuddy is looking for a sperm donor?

Kara’s medical care wasn’t that bad, but the pediatric medicine was sub-par. First, Chase is an adult intensivist, not a neonatologist, and the two are not interchangeable. Second, why did Mikey develop a pneumothorax? Infection (or pneumonitis) are not causes of a collapsed lung. Third, speaking of a collapsed lung, a needle thoracostomy is for treatment of a tension pneumothorax, not a spontaneous pneumothorax. The needle simply converts the tension pneumothorax into an open pneumothorax, which they neglected to treat. Fourth, I know ECMO machines look cool, but pneumonia is not an indication for using one (though bacterial sepsis can be an indication).

In terms of Kara’s treatment, isn’t it ironic that she was found to have a cancer after we were told in the beginning that the ER had categorically ruled out cancers? For Foreman, I’m glad to see he’s recovering, albeit slowly, but why is everyone convinced it was the biopsy alone that caused his problems. Meningitis takes at least a month of convalescence (which does not include going to a stressful job) before a person is anywhere near recovered. Finally, shame on House and Wilson (especially Wilson, as an oncologist he should know better). Tumor markers can be used to follow an established cancer or to check for a recurrence, but have no use in screening for tumors (except maybe the PSA — prostate specific antigen — in men, and even that’s open for debate).

The mystery was interesting and gets a B and the solution logically followed, earning a B+. However, the medicine and in particular the pediatric medicine was bad enough that I can’t give a higher grade than a C-. The soap opera component, particularly the Wilson/Cuddy “date”, had potential and deserves a B+.

• The previous House review
• A list of all prior House reviews

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Still want more great medical reading? This week’s Grand Rounds — the best medical blogging of the past week — are being hosted by Tara over at Aetiology. As usual, there’s an incredible amount of fascinating reading.

Tags: television medicine house celiac disease pellagra grand rounds

I’m sure that like most people contemplating the immigration issue you think to yourself, “What could early-Silver Age DC comics teach me about immigration and getting along with people who are different from me?”

Ponder no longer, for today’s PSA Monday page answers that very question. From the DC Comics published in September 1957*
comes the inspiring tale “Danger: Prejudice at Work” ** by Jack Schiff (words) and Ruben Moreira (art). As with most other Silver Age PSA ads, this was sponsored by the National Social Welfare Assembly.

In the end, this magnum opus reminds us once again that there is no problem in life that cannot be solved with baseball.

Click on the image for the full size PSA ad.

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*This PSA appeared in Action Comics #232, Adventure Comics #240, Batman #110, My Greatest Adventure #17, Showcase #10, Sugar & Spike #10, Superboy #59, Superman’s Pal Jimmy Olsen #23, and World’s Finest #90. Insome comics it was printed in color; in some, black and white. It may have appeared in the other DC comics that month, but I can’t confirm it.

**An ironic name, as the story is about play and not work.

Tags: comics psa silver age prejudice baselball

After last night’s list of the best in comic book medicine over the past year, tonight’s list takes a look at the very worst in comic book medicine in 2005, and unfortunately there were many nominees this year.

Worst Depiction of Medicine:
Without a doubt, the Operating Room scene in Richard Dragon #10 was the worst medical scene in comics this year, and probably the worst OR scene in comics ever.

Worst Doctor:
Sadly, Leslie Tompkins wins the Worst Doctor of the Year Award. Honestly, DC Comics and Bill Willingham should win this award for taking the easy way out to alleviate Batman’s guilt over the death of Stephanie Brown, and sacrificing a respected character to do so.

Worst Single Medical or Scientific Concept:
Aquaman #30 and the ridiculous “Kiss of Death” storyline, where people suffocated from too much oxygen.

Worst Imaginary Medicine or Treatment:
The “Military Strength Pain Killer” from Black Widow (yes, the same mini-series wins both the Best and Worst Awards). Pain is pain — the idea that people in the military get stonger pain killers is ridiculous; if anything, their choice of pain killers are more restrictive than civilians.

Dishonorable Mentions:
For comics that went benarth and below the call of duty, delivering scenes fraught with horrible medicine and science.

• Batman: Gotham Knights #61, where Hush believes resistance to poison ivy is rare, and the writer thinks that DDT is a weed killer instead of an insecticide.
• Ultimate Iron Man for that ridiculous brain-tissue-spread-throughout-the-body concept.
• Ultimate Fantastic Four #23, for Sue Storm “brain-damaging” a villain by “collapsing” a single synapse (out of tens of millions in an average brain) and for the optic nerve blindness foolishness.
• Batman #644 for showing the readers that basic high school chemistry is beyond Batman’s understanding.

Green Arrow #51 “The Return of Anarky”
James Peaty, writer
Eric Battle, penciler

Following the trail of some bank robbers, Green Arrow and Anarky stumble upon a dead body in an apartment.

Anarky: Rigor’s set in, he’s been dead for at least a day.

Anarky may be right — but if so, it’s nothing more than pure luck. His science and understanding of rigor mortis is flawed.

Under normal conditions, rigor mortis starts 3-4 hours after death with the facial muscles and then spreads to rest of the body. Full rigidity sets in at about 12 hours. Depending on conditions, rigor mortis lasts for 24-72 hours.

Cold conditions slow down the process, warm condition speed it up.

To understand how rigor mortis works requires a very basic understanding of calcium ions and muscle cells: The concentration of calcium ions is higher in the fluid surrounding muscle cells than inside the cells themselves. Nature likes concentrations to be equal, so calcium slowly leaks into the muscle cells. These increasing levels of calcium ions inside the muscle cells cause the muscle to contract. To counteract this and allow the muscles to relax, calcium is pumped out of the cells using adenosine triphosphate (ATP) to provide energy for the pump. After death, the supply of ATP quickly runs out and calcium begins to build up in the muscle cells. This leads the muscles to contract and become rigid because there is no way to pump the calcium back out. This is what causes rigor mortis. Eventually digestive enzymes within the cells become active and start breaking down proteins. This leads to a softening of the muscles and breaks the rigor mortis.

Anarky usually hangs out in Gotham City, so he probably learned his bad science from Batman.

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Why don’t comic book detectives ever mention algor mortis or livor mortis?

Algor mortis is the cooling of the body that occurs after death. It is a slow, steady decline until the body reaches temperature room temperature. The body’s temperature can be used to indicate the time of death, though environmental factors can affect the result.

Livor mortis is the discoloration of the body that occurs as the blood settles to the lower areas of the body following death. This can also be used to suggest the time of death.

Day Three of a three-day look at the use of biology in Grant Morrison and Frank Quitely’s All-Star Superman #1. (The previous parts can be found here and here). Today, we’re going to start where we left off yesterday: talking about the giant blue Voyager Titans.

Dr. Quintum: The blue skin is typical of these anaerobic meganthropes. His blood is 80% liquid nitrogen.

3. Anaerobic
Anaerobic literally means “without air”, though it is understood to mean “without oxygen.” It can be used in several contexts, but I’m just going to mention the two most common here.

First, there are some organisms, generally bacteria, that thrive in low oxygen environments. These are known as anaerobic bacteria. Clostridium tetani is a perfect example of one of these anaerobic bacteria. This is the germ that causes tetanus and can only survive in environments without oxygen, such as at the bottom of a deep puncture wounds. That’s why we give tetanus immunizations for dirty puncture wounds.

A second common use of the term anaerobic is in reference to exercise. Humans can produce energy both aerobically (with oxygen) and anaerobically (without oxygen). Aerobic exercise is good for long steady exercise such as walking, jogging, cycling, and – duh – aerobics. It is more efficient that anaerobic exercise, but not as powerful. On the other hand, anaerobic exercise is good for quick bursts of maximum speed or strength such as sprinting or weight lifting. The downside is that anaerobic exercise is not as efficient as aerobic exercise and produces lactic acid, a by-product which builds up and causes muscle fatigue.

In this instance, I suspect that Morrison is suggesting that these are anaerobic organisms. These giant men (mega + anthropes) are designed for space exploration and need to live in a low- or no-oxygen environment. The blue color suggests that they do not have oxygenated hemoglobin in their blood, which has a definite red color to it. This makes sense as they are anaerobic and would need no molecules specially designed to carry oxygen (like hemoglobin).

(Actually, both uses of “anaerobic” tie-in together, because an anaerobic organism needs to use an anaerobic metabolism to produce energy).

4. Liquid Nitrogen
Liquid nitrogen is nitrogen that has been converted to liquid form by high pressures and low temperatures. It has a boiling point of –320.5° F (-195.8° C). Above this temperature, nitrogen is a gas. At –320.5° F or below, nitrogen is a liquid. We have a medical term for that: damn cold.

Medically, we use liquid nitrogen to treat certain skin conditions such as warts, seborrheic keratoses and actinic kertoses. It is also used for storage and cryo-preservation of tissue samples.

I suppose that with the right technologic and genetic modifications, liquid nitrogen could be used in the bloodstream, replacing the water that is in ours. But just remember this: at a temperature above –320.5° F, their blood will turn to gas and a small puncture wound would become an explosive blow out.

5. Yoctosphere
Yocto- is a metric prefix that means 10^-24, or 0.000000000000000000000001. It is used to describe the size of atoms and sub-atomic particles. Thus “yoctosphere” would refer to the atomic and subatomic realm.

The Science of Super-Heroes has an interesting section on sub-atomic heroes.

This is the second of three posts on the biology in Grant Morrison and Frank Quitely’s All-Star Superman #1.

2. The Square-Cube Law

Dr. Quintum: Normal restrictions on human size and anatomy just don’t apply in weightless conditions.

What Dr. Quintum is referring to here is the Square-Cube Law. This is a fairly straightforward mathematical law which states that when you increase the size of an object by a factor of x, then its surface area will increase in proportion to x² and the volume will increase in proportion to x³.

This law applies not only to abstract objects, but to living organisms as well. When an organism increases in size, its surface area and volume increase by much larger amounts. This is vital in living creatures as both volume and surface area are important biological factors.

Let’s use Giant Man as an example. Hank Pym, normally 6 foot tall and 200 pounds, decides to grow to 30 feet (for the metricly inclined, normally 1.8 m tall with a weight of 90.7 kg, Pym grows to 9.1 m). Thus he is increasing his size by a factor of 5. His surface area increases by roughly 5² ( or 25). This is key because muscular strength is dependent on area. His volume increases by 5³ (i.e. 125). Weight corresponds with volume, so Giant Man now weighs 200 x 125 = 25,000 pounds (11,339.8 kg). The human body, even at 30 feet tall, is not designed to handle that kind of weight. His leg bones would snap like twigs and Giant Man would collapse on the ground in tremendous pain. He probably doesn’t even have enough strength to expand his rib cage to inhale, so he’d suffocate while he lay bleeding on the ground. He doesn’t even have the strength to scream for help (or even to whisper “Avengers Assemble” or “Avengers Disassemble”). Not a pretty picture, eh?

The human body seems to max out at around 8 feet, and even then, most people that tall have significant health problems.

Now I know that everyone is thinking about elephants and other large animals. Remember that these creatures have evolved over hundreds of thousands of years to be able to handle this extra weight. They are quadrapedal and fairly stocky with much stronger and heavier bones. However, even elephants have a maximum size dictated by the Square-Cube Law.

Dr. Quintum suggests that a weightless environment would allow an organism to escape these restrictions. That’s true…to a point. I suspect a weightless environment would allow for creatures to overcome the strength versus weight consequence of the Square-Cube Law. However, while that is the most graphic consequence of the law and the most common example, it is not the only limitation the Square-Cube Law imposes.

Surface area is a vital part of biology. For example, air exchange in the lungs and the absorption of nutrients from the gastrointestinal tract are both dependant on surface area. Increasing the size of an organism would increase its volume and mass to a much greater degree than the surface area of these organs. A creature that much larger than normal would have a difficult time getting enough air and other nutrients to function. Blood flow would be still another concern.

These restrictions could probably be overcome with the judicious use of technology and/or genetic manipulation, and Dr. Quintum seems to have both. Maybe Giant Man should give him a call.

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• A very readable paper on Comparative Anatomy and the Square-Cube Law.
• The Science of Super-Heroes has much more to say about the Square-Cube Law as well.

An interesting week and weekend in NASCAR. It really all started about two months back…

There had been some controversy since Roush Racing signed Jamie MacMurray to drive for the team in the 2007 season — the year after next. Since McMurray was still under contract to Ganassi Racing at the time, this was seen as “poaching” another team’s driver. It’s certainly not against the rules, just against one of the many “gentleman’s agreements” that seem to make up the NASCAR rules. A few weeks later, Penske racing signed Kurt Busch — one of Roush’s drivers — for the 2007 season and most commentators seemed content that some sort of cosmic karma had been satisfied. Busch immediately wanted his Roush contract canceled so he could start racing for Penske in 2006, but Roush would have none of it.

Jamie McMurray is a good driver and seems to be a genuinely pleasant person. The same cannot be said of Kurt Busch. He has been arrogant since starting the sport and only got worse after winning the NASCAR championship last year. He’s a decent enough driver — but not a great driver — and owes most of last year’s win to NASCAR’s ridiculous “Race for the Chase” playoff system. Though he certainly realizes that fact, he has spent much of the season spouting off in a manner that would make Muhammed Ali blush.

In the past few weeks, in what is known as “Silly Season,” teams hired and fired drivers for the 2006 season (now, whether the driver left the team or the team let the driver go often depends on who you ask). Michael Waltrip and Kenny Schrader are changing teams. Bobby Labonte (my favorite driver) left Gibbs Racing and signed on with Petty Racing (my least favorite team) — so I’m caught in a conundrum. On the midst of this, McMurry and Busch were both quietly let out of their contracts so that they could race for their new teams next year. Everybody’s happy…right? Wrong.

This past Friday night, Kurt Busch was caught speeding and running a stop sign in Phoenix. There is a report that there was alcohol on his breath and that he was less-than-nice to the officer involved. Given that Crown Royal is his sponsor, and he has made public service announcements about drunk driving, this was a dangerous irony. Roush suspended Busch for the rest of the season in a tersely worded statement essentially saying that they were washing their hands of him. Bear in mind that Busch is the reigning NASCAR champion and involved in this year’s “Race for the Chase” (though well behind in the points), yet he was suspended without a second thought. Maybe a little bad blood there? His brother Kyle, another driver, rallied to his brother’s defense and I’ve never seen someone put their foot in their mouth so often in a twenty-second sound bite.

Nothing caps off a week better than a healthy serving of schadenfreude.

Each unit in the American armed forces has its own coin. Usually made of brass and 1½ to 2 inches in diameter, these coins are generally struck with the unit’s seal, motto and other identifying information. Special coins are sometimes made to celebrate missions and other accomplishments. In addition, Unit Commanders have special coins that they hand out as a reward for a job exceptionally well done.

This link list a brief history of military coins. Here is more abbreviated history, but more importantly: the rules for the Coin Check, sometimes called the Coin Challenge. Here’s a stricter set of challenge rules. (When the docs and nurses from my clinic met after work for Happy Hour, we were frequently challenged because people apparently figured that the medical corps wasn’t military enough to carry coins — they were qucikly proven wrong. We could usually count on at least 2 free rounds each Friday).

I have a small collection of military coins. While some people traded for coins from other units, I stuck with coins from the units I was assigned to or served with, or missions I participated in.

This is the standard 820th RED HORSE coin. The front side shows the 820th seal and location. The back side has the unit motto around the edge. It also lists what the acronym RED HORSE stand for. Given that this was designed by one of the unit’s Chief Master Sergeants, it’s ironic that he screwed up the acronym. The first “E” stands for Engineers not Engineering.

When the 820th was deployed to the United Arab Emirates, it became the 820th Expeditionary RED HORSE Squadron. This second coin was cast to commemorate that mission. The front of the coin shows a stylized horse’s head/American flag combination. The back of the coin states “Operation Enduring Freedom” and lists how our contribution to the mission went. It may sound like bragging, but it’s really not. RED HORSE set an incredible record for the amount of tarmac laid in 6 months, particularly in a desert environment. The back of the coin also shows a map of the Middle East. The RED HORSE symbol is just above UAE where we were stationed. It’s hard to see on the smaller image (so click here for a larger one), but there is a hoofprint on the map for each project we contributed to while deployed.

While reading through some issues of Superman’s Girlfriend Lois Lane, I was astounded by how fickle Lois was. Allegedly in love with Superman, she seemed to be getting engaged to someone else almost every other issue. I decided to count how many time Lois had been engaged or married, and these are the results I came up with. You’ll notice that I’m not counting imaginary or future stories; only canon stories are listed (though admittedly most were pre-Crisis and pre-reboot). Also, I only have slightly more than half the issues of Lois Lane and a few scattered Superman titles so I’m sure there are many more engagements/marriages that I’m missing.

Engagements:

• Engaged to Dino Del Monaco in Superman’s Girlfriend Lois Lane #10 (July 1959). Lois met Dino while on an assignment in Italy. She broke the engagement when she discovered he was a con man. Reprinted in 80-pg Giant #3
• Engaged to the super-powered Native American Strong Bear in Superman’s Girlfriend Lois Lane #49 (May 1964). It turns out he was really an ugly little blue alien. Reprinted in Superman’s Girlfriend Lois Lane #113.
• Engaged to Epimetheus in Superman’s Girlfriend Lois Lane #56 (April 1965). Sent back in time, Lois becomes the Pandora of legend.
• Engaged to Titanman in Superman’s Girlfriend Lois Lane #79 (November 1967). Lois found herself in a bizarre alternate dimension where she was thrown in jail. She was rescued from prison by the super-hero Titanman and agreed to marry him only to discover that she would be his seventh wife. Luckily Superman was able to return her to her correct dimension before the wedding could take place.
• Engaged to astronaut Rand Kirby in Superman’s Girlfriend Lois Lane #80-81 (January, February 1968). After Superman misses her birthday party, Lois starts a new life in Coral City where she fallis in love with Kirby. (My reviews of these issues.)
• Engaged to Kryptonian scientist Dahr-Nel in Superman’s Girlfriend Lois Lane #90 (February 1969). After Superman’s upsets her with a fake wedding, Lois agrees to marry Dahr-Nel and escape to the future. (My review)
• Engaged to the demonic Satdev in Superman’s Girlfriend Lois Lane #103 (August 1970). I really can’t explain this one except to say that Lois’s curiosity manages to get her engaged to a satyr-like man from another planet.
• Engaged to Clark Kent in Superman (Second Series) #50 (December 1990) — engagement broken in Action Comics #720 (April 1996)
• Engaged to the criminal Naga in Superman: The Wedding Album (December 1996).
• Re-engaged to Clark Kent in Superman: The Wedding Album (December 1996).

Marriages:

• Marries Superman in Superman’s Girlfriend Lois Lane #82 (April 1968). The marriage was part of a plan to capture some criminals from the future. Superman offered to stay married, but Lois declined, wanting Superman to marry her for the right reasons.
• Marries death-row convict Johnny Adonis in Superman’s Girlfriend Lois Lane #105 (October 1970). Lois owes him a favor for saving her life, so she marries him shortly before he is to be exectured.
• Marries Clark Kent in Superman: The Wedding Album (December 1996).

Near-Misses:

• Lois is nearly engaged to Mark Benton in Superman’s Girlfriend Lois Lane #3 (July/August 1958). Mark Benton is suave and rich and looks exactly like Clark Kent. Lois is in love with him and Mark is going to propose, but her snooping makes him change his mind. Reprinted in Lois Lane Annual #1 and Superman’s Girlfriend Lois Lane #99.
• Lois may or may not be engaged to Roger Warner in Superman’s Girlfriend Lois Lane #24 (April 1961). Lois is dating the rich and very accomplished Roger Warner. They may even be engaged (the script seems to hint at it). They call it quits after a gust of wind blows off Roger’s toupee revelaing him to be completely bald. To be fair to Lois, Roger is the one who is ashamed and calls it off. Reprinted in Superman’s Girlfriend Lois Lane #88.
• Almost Engaged to Petronius in Superman’s Girlfriend Lois Lane #33 (May 1962). Sent back to the ancient days by a “time bomb,” Lois becomes involved in a slave revolt. The leader of the revolt Petronius has asked her to marry him and she is in the middle of saying “yes” when she is whisked back to her own time. Reprinted in Superman’s Girlfriend Lois Lane #95.
• Atlantean scientist Ron-Thul wants to marry her in Superman’s Girlfriend Lois Lane #42 (July 1963). She refuses to marry him when she discovers that he is evil — though the fact that he looked exactly like Luthor and his name was a near-anagram of Luthor should have given it away. Reprinted in Superman’s Girlfriend Lois Lane #104.
• Lois is forced to marry Clark Kent by a tribe of lost vikings in Superman’s Girlfriend Lois Lane #53 (Novemeber 1964). Luckily Superman rescues them before the ceremony can take place. Reprinted in Superman Family #177.
• Engaged to Herko in Superman’s Girlfriend Lois Lane #57 (May 1965). Lois travels to the dimension where her monster friend Herko lives. Herko wants to get married and tells everyone that they’re engaged, but Lois doesn’t share his sentiment. She escapes, dignity intact, when it turns out that Herko is allergic to her make up. Reprinted in Superman’s Girlfriend Lois Lane #113)
• Marries Superman in Superman’s Girlfriend Lois Lane #90 (February 1969). Superman stages a fake wedding with Lois to draw out some criminals. Unfortunately, he forgets to tell Lois that it’s fake and she flounces off in a huff to marry Dahr-Nel (see above).
• Biron wants to marry Lois in Superman’s Girlfriend Lois Lane #92 (May 1969). Lois and Biron are in love, but there’s a problem. You see, Biron is the human identity of Comet the Super-Horse. He asks the goddess Circe to make him permanently human so he can marry Lois, but an evil magician intervenes and turns Lois into a super-horse. This issue is more than a little creepy (and not in the good “Halloween creepy” way, more in the “I-need-a-shower-right-now creepy”).

Rigor Mortis is a stiffening of the muscles that occurs after death. It generally begins about 3 hours after death, peaks at 12 hours after death (depending on the environemental temperature) and lasts no more than than 24-36 hours.

Sorry Batman, but rigor mortis would be long gone by three days.

Image taken from Detective Comics #733 with script by Bob Gale and pencils by Phil Winslade.

I finally had a chance to sit down and read the House of M (and most of its offshoots) this weekend, and I enjoyed it more than I expected. It got off to a incredibly slow start with House of M #1, but the subsequent issues really picked up the pace. The various offshoot title were mostly enjoyable as well, though I was underwhelmed by the art on Iron Man: House of M.

The main problem with the title is a problem shared by almost all “alternate reality” titles: it lacks permanency. As readers, we know that the storyline is only a temporary one and we are reluctant to invest in the characters and storylines. Sure, there may be some ramification when it goes back to “normal” , but we all know that soon the status quo will return.

The Elseworlds stories avoid this problem by telling stories that are set in their own world, not one that is a perversion of the normal one. Unfortunately most Elseworlds stories are too short for the reader to really care much for the characters. The Ultimate Universe is another example of an alternate world in and of itself, not simply a change in the regular world. Unlike the Elseworlds, the Ultimate Universe has been around long enough to develop some good character depth. Some of DC’s “Fifth Week” events were also able to create alternate universes with a sense of permanancy. You knew the Tangent Universe existed before we read about it and would continue afterwards. The Amalgam Universe pulled this off particularly well with editor’s notes referring to supposedly previously published Amalgam comics.

The Best Alternate Universe Stories* (in my humble opinion):

1. The Tangent Universe
2. Golden Age
3. The Amalgam Universe
4. Thrillkiller and Thrillkiller ‘62
5. The Ultimate Universe
6. House of M
7. Superman/Wonder Woman: Whom Gods Destroy
8. Age of Apocalypse
9. Superboy’s Legion
10. The Nail (but not so much its sequel, that was just too busy)
11. Superman: Red Son

The Worst?
Anything involving Kulan Gath is bad, but the absolute worst? Without a doubt that would be the year that was Heroes Reborn.

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*I’m not counting any “alternate futures” because they haven’t happened yet, with the exception of Superboy’s Legion which is an alternate version of an already established future.

As always, here at STAR Labs we’re on the cutting edge of technological advancement. We’re now pleased to announce the latest in super-hero costume convenience: OnSTAR, the satellite assistance network available at the touch of a button. Ask for it by name when you buy your next costume!

To demonstrate the uses of OnSTAR, the following are real unscripted, unedited customer calls:

OS: This is OnSTAR. How may I assist you Iron Man?
IM: I’m fighting Dr. Doom and he’s taken control of my armor. I’m locked out!
OS: Just a minute, let me trigger the remote lock….there! You should have access now.
IM: Thanks OnSTAR!

OS: This is OnSTAR. How may I assist you?
SM: Yeah, well, I’m supposed to be meeting up with the police to help with a hostage crisis at the First National Bank, but I’m here at the corner of 11th and West and there’s no one here.
OS: That’s because you’re at Second National Bank. You want to fly about ten blocks north.
SM: Umm, which way is north?
OS: Just fly towards the water tower for a few minutes and you’ll find the bank.
SM: There it is! Thanks OnSTAR!

OS: This is OnSTAR. How may I assist you Booster Gold?
BG: I…tried to [gasp]…stop…Gorilla Grodd
OS: Do you need the JLA? I repeat: do you need the JLA?
BG: I can’t…find…my leg…
OS: The JLA are on their way. Just hold on another few minutes.
BG: Thank you…OnSTAR.

With OnSTAR, assistance is just the touch of a button away! Ask for it by name!

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Assistance available only on Earth and its immediate vicinity and time period. Offer not valid on other planets, dimensions, hypertime, hyperspace, or alternate realities. Offer not valid in Iowa. The OnSTAR system is prone to explosions when in close proximity to zeta beams. Actual assistance by the JLA not guaranteed. Not available to villains.

Aquaman #31, the conclusion to the “Kiss of Death” story arc, was marginally better than the preceding issue – mostly because it wasn’t as deep into pseudo-scientific mumbo-jumbo and bad medicine.

The Kiss of Death storyline:

A serial killer is stalking Sub Diego, killing people by breathing into their lungs. In order to find a pattern to the killings, Aquaman talks to Arkham Asylum inmate Jonathan Crane (the Scarecrow) who points out that the initials of the victims, plus the letters CA, will spell out “I can’t take it anymore.” With this, Aquaman concludes that the killer’s next victim must have the initials “CA.”

Aquaman, Lorena, and the remaining members of the police department split up to find the killer. With his keen detective skills, Aquaman has a good idea who the killer is — and he’s right. The killer has a gun that shoots paralytic darts, but Aquaman and Lorena are able to restrain and imprison the killer.

The basic concept of the story is sound: a serial killer is loose in Sub Diego. The execution of the story could have been better.

The scientific and medical technobabble was painful to read. I discussed most of it at length last month (as did Scipio). In terms of this issue, I will just quietly point out that it would be very hard for someone who is paralyzed to talk.

Another problem with the story is that the serial killer doesn’t act like one. Serial killers are disorganized thinkers. They kill to relieve a mental itch and prove their superiority (superiority over whom varies by the killer). While they may taunt the police with letters or notes, it’s quite a stretch to think that one would plan ahead enough to spell out a phrase with the victim’s initials, or as another example, base murders on the seven deadly sins. (I’ll readily admit that I’m not a forensic psychologist so my understanding of serial killers may not be 100% complete.)

Finally, I was very impressed that the Scarecrow was able to take the letters EONTMRNYTAEIITAK and right off the bat realize that — with the addition of two other letters — it spells out I CAN’T TAKE IT ANYMORE.

This is particularly impressive considering that the original letters by themselves can be rearranged into over one-hundred-thousand legitimate anagrams. My favorites include:

A termination tyke	Animate inky otter	I’m no karate entity	Into karate enmity
Attain inky remote	Into a meaner kitty	Iranian tyke totem	Marinate one kitty
Irate titan monkey	Emanate iron kitty	Token Martian yeti	Notary intake time

I think any of these probably would have led to a better story.

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• Internet Anagram Server
• Crime Library: Serial Killers

Once again, pregnancy and child-bearing has become an issue in comics, thanks to Avengers Disassembled and now House of M. I figured this would be a good time to take another look at the list of Comic Book Pregnancies.

Heroes:
ADAM STRANGE
1. Alanna dies during childbirth.

ANIMAL MAN
1. Annie was pregnant and gave birth in the last issues of the series.

AQUAMAN
1. Dolphin and Garth (Tempest) had a son, Cerridan.
2. Mera’s pregnancy happened “off camera”.

AVENGERS
1. Scarlet Witch’s pregnancy was shown in the Scarlet Witch and the Vision mini-series, though her twins were later ret-conned out of existence. This led her to become murderously insane and now crossover-miniseries-murderously insane.
2. Ms. Marvel was pregnant*

BATMAN COMICS
1. Spoiler was pregnant and gave her child up for adoption in Robin; she later died during Wargames.
2. Francine (Man-Bat’s wife) was pregnant in Batman in the 1970’s.
3. Batman and Talia had a son in the more-or-less non-canon Son of the Demon (though the pregnancy was pretty much “off screen”

FANTASTIC FOUR
1. Sue Richards had Franklin, and then lost her second pregnancy. A magical/time-stream induced third pregnancy recently gave the Richards a daughter, Valeria.
2. Lyja Storm was pregnant and gave birth to an egg.
3. Crystal and Pietro (Quicksilver) have a daughter Luna. Reed Richards (apparently an obstetrician in his spare time) delivered the baby.

FLASH
1. Iris was pregnant with twins at the time that the silver age Flash (Barry Allen) died.
2. Linda West lost twins due to an attack by Zoom. There is some question as to whether she’ll be able to become pregnant again.

INCREDIBLE HULK
1. Betty Banner was pregnant, but miscarried.

IRON MAN
1. Pepper Potts was pregnant, but miscarried.

JLA
1. Sue Dibny was pregnant when she was killedin Identity Crisis #1

JSA
1. Hawkgirl was pregnant as a teenager and gave the child up for adoption.
2. Dove was raped by Hank Hall (Hawk) and later gave birth to a child who ultimately ended up housing the soul of the new Dr. Fate, Hector Hall.

INFINITY INC.
1. Hippolyta Hall was pregnant a *long* time, and ultimately gave birth to Daniel (who was taken from her by Morpheus to become the new Sandman).

KILLRAVEN
1. Carmilla Frost discovered she was pregnant in the Killraven graphic novel.

LOSH (1)
1. Garth Ranzz (Lightning Lad) and Irma Ranz (Saturn Girl) had twins. (Twins are the usual on Garth’s home planet Winath; however, twins are determined maternally and Irma come from Titan. Plus are the twins fraternal or identical? Both have been shown on Winath in the series.)

LOSH (2)
1. In the “five years later” Legion, Night Girl was not only married to Cosmic Boy, but also pregnant.
2. Laurel Gand had a child by Rond Vidar.

LOSH (3)
1. Apparition (Tinya Wazzo) and Ultra Boy (Jo Nah) have married and had a child (Cub).

L.E.G.I.O.N.
1. Stealth had a child by Vril Dox.

MIRACLEMAN
1. Liz Moran gave birth in Miracleman #9.

MR. MIRACLE
1. Beautiful Dreamer was pregnant and gave birth.

NOBLE FAMILY
1. Zephyr became pregnant after a spiteful “night of passion” with her family’s greatest enemy.

SABRE
1. Melissa Siren was pregnant and gave birth in Sabre.

STARMAN
1. Jack fathered children with the Mist (see below) and his significant other, Sadie.

SPIDER-MAN
1. Gwen Stacy had twins after an ill-advised tryst with Spider-Man’s greatest enemy: Norman Osborn (the Green Goblin).

TEAM TITANS
1. Donna Troy was pregnant at the beginning of this series. Her husband and child died in a car accident, and then she died in Graduation Day.
2. Mirage was pregnant at the end of the series.

X-MEN
1. Madelynne Prior was pregnant with Scott Summer’s child (and gave birth to him) in the Uncanny X-Men. This child later went on through a very convoluted storyline to become Cable.

Villains:
Punch & Jewlee
They showed up in Hawk & Dove toting a toddler, but I don’t know if the pregnancy was ever mentioned or shown in Suicide Squad or elsewhere.

Chesire
Gave birth to Lianne, fathered by Speedy/Arsenal (Roy Harper), but I don’t know if the pregnancy was shown.

Mist
Had a child by Jack (Starman). Do not recall if the pregnancy was shown.

Non-Super-Hero:
FABLES: Snow White became pregnant after a drug-induced night with Bigby. She later gave birth to a litter of wolf/human hybrids.

STRANGERS in PARADISE: Francine miscarried.

ELFQUEST is chock-full of pregnancies and births. I’m not conversant enough with the series to comment.

Characters UNABLE to become Pregnant:
1. Black Canary – Sustained tortue injuries in Green Arrow: Longbow Hunters that rendered her sterile. Her recent dip in a Lazarus pit may have reversed this.

2. Firestar – Using her powers will cause her to become sterile. Hank Pym developed a costume for her that repairs the damage.

*Explanation per