Polite Dissent

The plot of this episode of Fringe was, at best, so-so. They could have at least played up the “trapped in a building with a possible killer” angle. The science — and it’s generous calling it that — was painfully bad.

The Plot: In a large office building in Boston, a man walks into the office of a petroleum corporation, then drops dead, with his last breath spraying a fine mist of blood on all around him. Given the strange nature of the man’s death, the Fringe team is called in. Peter and Olivia arrive first and are interviewing bystanders. Walter, Broyles, and Astrid are on their way into the building, when one of the people exposed to the dead man’s blood comes walking toward the door, as fast as he can. Walter quickly shuts the door before the man can escape, and the man dies, spraying blood against the closed door. Fearful of an unknown contagious disease, the CDC is called in and the building quarantined — with Peter and Dunham still inside.

Some blood samples are obtained, and Walter takes them back to his lab. In the office building, the receptionist falls ill. Doing a little detective work, the team determines that the first dead man was a corporate spy from Dubai who was selling information on the peteroleum company’s competitors. The ill receptionist becomes frantic and violent. She scuffles with Peter, then jumps through a window, plummeting to the street below, dead. Unfortunately, Peter has been exposed to infected blood and now may be infected himself.

Inspecting the car of the corporate spy, the FBI and Center for Disease Control (CDC) find a core sample from 10 miles down that he was trying to sell. They also find the mysterious virus behind the outbreak contained within the core sample. Walter speculates it is 75,000 years old and was responsible for killing most of the mammals on Earth during the Ice Age (as opposed to the ice and cold). From this virus, Walter is able to concoct a test to determine who is infected and who isn’t. Walter believes that the virus has human-level intelligence and is purposefully acting to infect as many people as possible. He and Astrid enter the office building and test the staff. Most are not infected. Peter is showing signs of infection, but through sleight of hand, makes sure he has a negative test. The people who tested clean are escorted out of the building — except Peter. The guard at the door (a competent FBI agent at Fringe?) notices he has a nosebleed and keeps him in quarantine. In the end, eleven infected individuals remain in the building. Walter and Astrid also elect to stay.

Walter deduces that sulfur is a cure for the virus and relays the information to Dunham. Meanwhile, the CDC has called in the US Army to “take care of” the people remaining in the building. Dunham and Broyles ask for more time to synthesize Walter’s cure. Broyles suggests pumping the building full of Fentanyl gas (a strong narcotic) to knock everyone out and buy time. Dunham volunteers to enter the building and turn the HVAC back on. She scuffles with an infected Peter but succeeds in her mission. All the infected people are knocked out, Walter’s cure is made, and everyone (well, except for those already dead) survives.

It’s been a number of years since I’ve worked in a biochemistry or infectious disease lab, and I found the “science” in this episode totally appalling. I’m sure any actual infectious disease researcher or biochemist who watched the show had their television explode from the rays of frustration and hate their brains emitted. I’ll highlight a handful of items, but there are many more mistakes and plot holes that I didn’t have time to mention because I actually do have to get some sleep tonight.

1. I Give Him Credit For Trying
I applaud the bike messenger for attempting CPR (even if it was the 5 compression/1 breath technique that is not recommended anymore), but give it some time before you declare the guy dead. Ten compressions doesn’t cut it. At least continue the CPR until the EMTs arrive.

2. You Know What They Say About “Assume”
Walter believes the virus is transmitted by bodily fluids. How does he arrive at this conclusion? Certainly blood transmission seems probable, but how does he know about other bodily fluids? Is he surreptitiously testing saliva and semen?
He claims the virus is not airborne, or more people would be sick. How is he so sure about the incubation time? Maybe more people could be sick than he knows, they’re just not showing it yet. Sure, the bike messenger fell ill fast, but how do you know he was not exposed before (maybe the Dutch guy wasn’t patient zero), or maybe the messenger had a weakened immune system and succumbed faster than normal. Walter is making way too many assumptions.

3. Do You Even Know What You’re Testing For
There are way too many problems with Walter’s test.
Why the cheek swab? That’s used for DNA samples. Is he saying the virus can be found in the DNA of cheek cells?
Most viral tests look for antibodies against the virus — they’re a lot easier to develop. Of course, it usually takes several weeks for these antibodies to appear. There are some tests that look for the actual virus, but I don’t care how much of a genius Walter is, he couldn’t have cobbled one together so fast, or made enough of it to test the entire office building.
Most importantly, there was no prior testing to determine the false negative/false positive rate of Walter’s test. No test is 100% right all the time. They are risking everybody’s life on an unknown test.
Then Peter’s test was negative but he clearly was infected. We the viewers know he faked the test swab, but the characters don’t know that. Their first thought would have been: “Peter’s test was negative, but he has the disease. How many of these other people we let outside also had false negative tests?” And then they would have hustled them all back inside and left them there.

4. If Only My Labs In College Were This Easy
The scene in Walter’s lab was laughable.
No protective gear.
Isolating a virus in a test-tube using a centrifuge (and using it poorly) would never work. It’s not even close to being right.

5. Down In The Hole
Admittedly, I’m not a geologist, but how does 10 miles down equal 75,000 years. I would think it would be a lot more (years) than that.
The virus lived 75,000 years without a host — that’s impressive. Plus this virus can apparently be visualized without an electron microscope.

6. It’s A Gas
Fentanyl gas has been used at least once before to subdue a building full of people. In this case, it was a hostage situation in Russia with Chechnyan separatists. The Fentanyl didn’t work as well as expected and actually killed 117 hostages. In situations like that, it’s hard to control the inhaled dose — and Fentanyl can kill at the wrong dose. Plus, a fair number of people are allergic — fatally allergic — to narcotics.

7. Dire-Swine Flu?
Neuraminidase inhibitors are used to treat influenza viruses and … that’s about it. So this is a flu virus now

8. Eli Lilly Is Spinning In His Grave
In vivo does not equal in vitro. In other words, what works great in a test tube often doesn’t turn out to work so well in an actual living organism. If creating a new drug were as easy as Walter makes it out to be, we’d be neck deep in fancy new medications and the pharmaceutical companies wouldn’t be laying off people left and right.

9. Not So Smart, Is It?
If the virus really wanted to infect as many people as possible, why not infect the airplane instead of an office building? Those people would be in an airport and then other planes, not trapped in a building.

8. Nice Try, But…
The US Army is not authorized to act on US soil. National Guard, maybe.

9. Georgia On My Mind
I’m not sure of the actual powers of the CDC in a situation like this, but this seemed unrealistic to me. Their response was incredibly fast and a lot like a sledgehammer. I’m not saying the CDC isn’t fast — they are easily the best in the world at what they do — but they’re not that fast. And they actually do research, rather than just shoot people. Wait, was that a knock at the door?

I thought last week’s science was bad, but this was even worse. I have no choice but to move the Fringe Doomsday Clock forward two minutes to 11:58.

Tags: television fringe mutation virus infection cdc

In this scene from the Monkeyman & O’Brien Special #1, two thugs are psychically dominated by the mind of an evil white space gorilla.

As an added bonus(?), have some fan service, courtesy of artist/writer Art Adams.

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Tags: comics medicine nosebleed monkeyman o’brien art adams fan service

The mystery was fairly bland in this week’s episode of House, but the medicine was much better overall. Good bye Cameron. Don’t let the door hit you on the way out.

Hank, a successful porn star is admitted to Princeton Plainsboro Teaching Hospital after developing a severe headache and photophobia (sensitivity to light) while on set. House starts off by ordering a series of tests: an STD panel (to look for sexually transmitted diseases), a toxin screen (to look for common toxins), C-Reactive Protein (”CRP”, a measure of inflammation), ANA (antinuclear antibodies, to look for autoimmune diseases) and a lumbar puncture (to look for viral encephalitis). While the patient is having his spinal tap performed, he develops severe muscle spam and pain (tetany) in his arms. Foreman orders meperidine (Demerol, a strong pain medication).

About this time, House starts hitting up Taub and Thirteen for ideas, trying to lure them back on the team. Taub suggests that Hank must have a brain problem, such as a tumor or seizure. Foreman believes that Hank suffers from cerebral vasculitis (inflammation of the blood vessels in the brain). House agrees with Foreman’s assessment and starts the patient on steroids. He also orders a brain angiogram (an x-ray of the arteries in the brain), as well as an EEG and a nerve biopsy, just to be sure. Foreman convinces Chase to perform the angiogram, but he and Cameron suspect that the patient is suffering from Vitamin D deficiency, so instead of checking the angiogram, they decide to start Hank on light therapy and intravenous vitamin replacement. Unfortunately, while undergoing the light therapy, Hank develops a nosebleed and is found to have petechiae on his legs.

Hank is now diagnosed with disseminated intravascular coagulation (DIC, a weird, but very serious, condition, where the patient is both bleeding too much and clotting too much). Sepsis is suggested as a possible cause, but since he is showing none of the shock associated with sepsis, the idea is discarded. Bacteremia (bacteria in the blood) is suggested, but Cameron shoots it down suggesting instead Meningococcemia (meningococcal bacteria in the blood — really a subset of what Chase suggested). House concurs with Cameron’s diagnosis and Hank is started on heparin (a blood thinner, for the clots) and a broad spectrum antibiotic that covers meningococcus (but if you know which bacteria you’re treating, then you don’t need a broad spectrum antibiotic).

Hank does not improve and he starts to run a fever. Taub suggests that he might have an infection hidden away in his sinuses, where the antibiotics have difficulty reaching, so Chase performs sinus surgery to clear out the sinuses. Now Hank begins to complain of severe abdominal pain and Cameron discovers something on the exam (apparent ascites — fluid in the abdomen) that makes her diagnose liver failure. She suggests a Klatskin tumor (cancer of the bile duct), but it doesn’t quite fit the symptoms. Foreman suggests that Hank has sclerosing cholangitis (a disease that damages the bile ducts). House agrees and an ERCP (an endoscopic exam of the bile duct and pancreas) is ordered — surprisingly it shows a mass in the common bile duct that ends up being a large clump of worms. Hank apparently has strongyloides (”whipworm threadworm”), and is given mebendazole to kill the worms.

Once again, Hank’s condition dramatically worsens. He develops severe pulmonary edema (fluid build up in the lungs). Chase thinks it might be a combination of a hematological (blood) problem and cardiomyopathy (a heart problem). Foremen suspects Hank has lymphoma, with peritoneal carcinomatosis (malignant spread of cancer across the abdomen) and paraneoplastic syndrome explaining his symptoms. House sides with Foreman, and Hank is started on chemotherapy. A short time later, Hank’s condition takes another turn for the worse when he starts urinating blood. Next, his blood pressure and heart rate skyrocket, and he starts to bleed from his mouth. He then suffers a cardiac arrest, but the team is able to stabilize him.

The latest labs are back and show that Hank barely has any red blood cells, white blood cells, or platelets. The differential diagnosis now includes hypopituitarism (an underfunctioning pituitary gland), renal cell carcinoma (a type of kidney cancer), or aleukemic leukemia (a leukemia that is associated with low white blood counts instead of the normally high counts found in leukemia). House tells the team that the latter is the most likely and orders them to ablate (destroy) Hank’s bone marrow in anticipation of a bone marrow transplant. There is a lot of hemming and hawing about whether this is the right thing to do, since it could make Hank sicker or kill him, but at the last moment, Thirteen and Taub call in with the correct diagnosis: extraintestinal Crohn’s disease. According to them, Hank’s exceptionally clean childhood made him more likely to develop diseases such as Crohn’s, and the worms were actually helping him keep the disease in check. Once the worms were killed off, the Crohn’s flared up with a vengeance. With some methylprednisolone (steroids), Hank should get better — but the team wants to give him some worms again, just to make sure.

I found no massive errors in tonight’s episode. There was the usual: jumping randomly between unrelated diagnoses, bizarre test interpretation, and Chase being a specialist surgeon, but nothing horrible. Of course, that’s not to say I have no complaints (as if!). As usual, minor complaints are in blue, nit-picking ones in green:

Where exactly was the extraintestinal focus of the Crohn’s?

Why did he develop a headache and photophobia in the beginning? Was that the Crohn’s? Why did everything suddenly worsen when he got in the hospital? The steroids he was given for the vasculitis should have calmed down the Crohn’s.

The strongyloides worms may not have been the cause of his disease, but their blockage of the bile duct would still cause serious problems for the patient.

Again, no oncologist is going to start chemotherapy for cancer without a tissue diagnosis.

Special precautions are taken for patients who are neutropenic (dangerously low in white blood cells, and thus more susceptible to infection) including gowning and gloving everybody in contact with the patient. You do not roll them down the hospital’s common hallway without a mask and with the wife holding his hand.

The CRP should have been significantly elevated with the Crohn’s disease (and the cerebral vasculitis too).

While the ANA is generally strongly positive for certain types of autoimmune diseases, it is not found in every autoimmune condition (or even most autoimmune conditions), so a negative ANA does not mean there is no autoimmune disease (and positive ANAs in the absence of autoimmune pathology are also possible).

How about checking the vitamin D level — an easy thing to do — before treating the patient.

I noticed how they avoided actually saying the word “ascites” and instead chose a wordier explanation. Probably because of their problem pronouncing it last time.

Cameron shoots down Chase’s idea of bacteremia, but then suggests meningococcemia, a type of bacteremia. The same argument she used against Chase would go against her as well.

Why would you ablate the bone marrow without finding a donor first? (OK, maybe House was never planning on really following through with it, but why would the others go along?)

And now credit where credit is due:
The hygiene hypothesis is a legitimate and controversial scientific theory concerning the rise in asthma and allergy rates in industrialized nations. Some researchers link it to autoimmune diseases as well.
Helminthic therapy — treatment of disease using intentional infestation of parasitic worms — is being tested in a variety of diseases, including Crohn’s/
Shocking ventricular tachycardia, like Foreman did this episode, is the right treatment.

The mystery was okay, but seemed to get lost in the shuffle as the show progressed. I give it a B. The final solution was a stretch, especially when you look back at the original symptoms. It earns a C. Overall, the medicine was better that it has been the past few weeks and earns another B. The soap opera was decent as well. I enjoy Tab and Thirteen, so I’m fine with having them back, though I know many will disagree. The soap opera earns still another B.

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

The House Challenge scores are now up to date here.

An incredibly mediocre show that didn’t meet a cliche it didn’t like (except, unfortunately, the psychic nosebleed). Sorry if the write up seems brief, but I’m really having a hard time caring about this show recently.

The Plot:The police are called for a kidnapping/hostage situation at the top of a parking garage where two guys are holding a teen hostage in a car. When the police arrive, they order the men out of the car. The duo get out of the car and then strange things begin to happen: one cop backs up and throws himself off the garage, while his partner shoots the other cops and then herself. The two guys get back in the car and drive off with the kid.

The Fringe team is called in to evaluate the case. Walter suspects that there is hypnotism of subliminal messages involved. The team heads to Massive Dynamic because the kidnapped boy is the son of one of their top aerospace researchers. By now, the two guys in the car have been identified as two local used car salesmen who had been upstanding citizens until now. The kidnappers and teen stop by a convenience store and ob it. A burly customer tries to intervene, but suddenly he is pouring scalding coffee over his head and the breaking the carafe over it. The cashier tries to shoot the men, but finds himself picking up a key and inserting it into an outlet and shocking himself unconscious.

Walter has been performing an autopsy on the cop who shot the other cops and deduces that it was not hypnosis, but instead mind control. He makes his deduction based on the fact that there are hematomas (pockets of leaked blood) on the surface of the brain, suggesting some mind/body conflict. He then infers — for no good or logical reason — that this mind control must be done via the cochlear (hearing) nerve.

A call comes in from the kidnappers demanding two million dollars. Meanwhile, Walter has concocted white noise headphones for the FBI troops to wear in the field which should block out any mind control. At an abandoned factory, the teen’s father hands over a briefcase of money to the kidnapper, who then runs into a nearby building. Agent Dunham follows. Meanwhile, Peter sees someone else running with the briefcase and follows, only to find the teen, Tyler, holding the briefcase. It turns out Tyler’s the one with mind control and the others were nothing but patsies. Unfortunately, Peter’s white noise headphones don’t protect him and Tyler orders him to drive the two of them out of town in the Bishop family roadster.

Peter tries to rebel, but Tyler forces him to drive the car as fast as it can go and plays chicken with a truck before Peter agrees to behave. A little while later, they are pulled over by a policeman. Tyler wants Peter to shoot the cop, but in the end, he lets Peter just knock him unconscious. Finally, Tyler and Peter arrive at his mother’s house (by way of a strip club), where Tyler finally gets to meet the goal of his quest — his mother. He believes that his father had driven her away and lied to him about her, but that turns out not to be the case, and when he learns she is married he has Peter pull out a gun and point it at her husband. Luckily, Agent Broyles arrives and shoots Tyler with a taser — but it’s a bad shot. Tyler has Peter shoot Broyles, and then he and Peter hop back in the family roadster and take off. Agent Dunham, Astrid and Walter are following close behind, and when they get near off, Walter activates the EMP device he has been working on. It knocks Tyler out for a split second, and that’s enough for Peter to realize what is going on and drive into a telephone pole. He survives with a mild concussion, but Tyler is knocked unconscious and captured.

1. Watching Too Many B-Movies, and Now I Need Some Popcorn
Walter’s original suggestions were nonsense. As Peter pointed out, hypnosis doesn’t work like that — and subliminal messages don’t work at all.

2. La La La! I Can’t Hear You!
Why go through all the elaborate set up of the white noise headphones instead of just using ear plugs?

3. Bleeding On The Brain
Hematomas don’t form with brain/body conflict. There are certainly medical conditions with conflict between mind and body — somatization comes to mind — but none of them cause hematomas. You could argue that the straining led to an increased blood pressure which popped the vessels, but high blood pressure related bleeds occur within the brain, not on the outside.
That was a surprisingly intact brain for someone who received a bullet at point black range.

4. On the AM Radio
Why amplify the brain waves — that should have been the team’s first realization that something wasn’t kosher — why not just make better sensors?
Amplifying the brain waves means that you are increasing the voltage within the brain itself, which is wonderful way of setting off a seizure.

5. It’s Better Than The 10% Cliche, But Just Barely
Brains are not computers. Whenever someone uses this analogy, it’s a safe bet that they don’t understand brains or computers
Having Tyler’s mother actually be a surrogate was a fairly clever twist — really the only one in an episode thick with clichés — but how does the doctor raise all five Tylers? Are they frozen until needed? Does he spend one day of the week with each one?

6. The Blind Leading the Blind
Geez, Olivia is a bad detective. She already knows Tyler’s mother died when he was young, and then can’t figure out why he’s looking at records of women who died in car crashes fourteen years before.

7. Crime And (Lack of) Punishment
Why would Tyler get off with just seeing some psychiatrists? That makes no sense at all, especially the way they explain it. He was directly involved in the murder of five people, the maiming of three others, and at least three attempted murders. He’s fifteen — old enough to be tried as an adult.

Why exactly am I still watching this show? I’m sure I have much better things to do.

Tags: television medicine fringe mind control hypnosis subliminal

Magneto lands on the X-Men’s island Utopia, but Professor Xavier is not particularly happy about it and lashes out.

Uncanny X-Men #516, by Matt Fraction and Greg Land

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Tags: comics medicine nosebleed x-men magneto xavier

Elasti-Girl is taken over by Mento, grown as tall as her powers allow, and then used as conduit for Mento’s psychic powers. The results aren’t pretty for the locals, or for Elasti-Girl.

Doom Patrol #3, by Keith Giffen and Freddie Matthew Clark

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Tags: comics medicine nosebleed elasti-girl mento doom patrol

When and why did placing the hands on either side of the forehead become the official pose of telepaths and other comic book psychics?

I figure there are several possibilities why:
1. The brains of psychics are heavier than normal — especially when using their powers — and they need the extra support.
2. It’s an aiming device.
3. Psychic powers cause migraines and they’re massaging the sensitive spots.
4. It increases downforce, in case one of those pesky psychic winds comes along. It also helps them in cornering on banked tracks.
5. They close their eyes when concentrating and it prevents them from bumping into anything if they start walking around.
6. It prevents a psychic nosebleed.

As for when , as far as I can find (in my admittedly brief search), it goes back to X-Men #3 (January 1964):

From Irredeemable #1, Samsamus is being questioned by his former teammates about the hero-turned-villain Plutonian. For reasons I don’t want to divulge (for fear of giving too much away), Samsamus is not only having trouble remembering, but develops a telling nosebleed.

OK, I’ll give a little (just a little) away by mentioning that this is the first post-mortem psychic nosebleed I’ve posted.

Irredeemable, by Mark Waid and Peter Krause

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Tags: comics medicine nosebleed irredeemable mark waid

In this scene from Final Crisis Aftermath: Run! #4, General Immortus is trying to exert his dominance over the Human Flame. The Flame can barely resist at first, but eventually manages to stand his ground and triumph. Sure, he suffers a nosebleed in the confrontation, but the General suffers third-degree burns.

Final Crisis Aftermath: Run! #4, by Matt Sturges and Freddie Willimams III

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Tags: comics medicine nosebleed human flame matt sturges

An old rivalry is altered when bizarre super-powers emerge in this scene from the nicely quirky (not to mention Lovecraftian) North 40 #2.

North 40 #2, by Aaron Williams and Fiona Staples

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Tags: comics medicine nosebleed north 40

While Team 7 is looking for abandoned nuclear weapons deep in the Cambodian jungle, they are ambushed by a pair of Soviet psychics. Here, Jackson Dane (later the leader of Wetworks) is under psychic attack by one of the Soviets.

Team 7: Operation Hell #3, by Chuck Dixon and Chris Warner

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Tags: comics medicine nosebleed team 7 chuck dixon

Here’s Gabriel — Miles Craven’s pet psychic — again. This time he’s the victim of a psychic nosebleed when he visits the mysterious ninth floor, where IO looks locks up their failed psychic genetic experiments.

Team 7 #2, by Chuck Dixon and Aron Wiesenfeld

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Tags: comics medicine nosebleed gabriel chuck dixon

In another scene from the first Team 7 mini-series, Miles Craven’s psychic associate Gabriel uses his powers against Cole Cash (later known as Grifter). As future weeks will demonstrate, this is the only time Gabriel actually proved himself to be useful psychically.

Team 7 #3, by Chuck Dixon and Aron Wiesenfeld

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Tags: comics medicine nosebleed grifter team 7 chuck dixon

An evil Soviet psychic is attempting to locate the members of Team 7 deep within the jungles of Cambodia. Not only is she unable to find them, but she encounters an unknown telepath — one who is stronger than she is.

(And whatever happened to that Cambodian psychic, X’ing X’iang? As of the last issue of the final Team 7 mini-series, she was imprisoned within the Internal Operations building. Is she still there?)

Team 7: Operation Hell #2, by Chuck Dixon and Chris Warner

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Tags: comics medicine nosebleed team 7 chuck dixon

For a change of pace, here’s a psychic ear bleed, and a fatal one at that, from a throwaway scene in Team One: Stormwatch #1

Team One: Stormwatch #1, by Steven Seagle and Tom Raney

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Tags: comics medicine ear bleed team one

In this scene, Cole Cash is using his new found powers to determine whether or not Miles Craven intentionally exposed Team 7 to the Gen Factor (hint: he did).

I’m pretty sure the various Team 7 mini-series have more psychic nosebleeds per issue than any other series I’ve encountered.

Team 7 #2, by Chuck Dixon and Aron Wiesenfeld

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Tags: comics medicine nosebleed grifter team 7 chuck dixon

Dink here is demonstrating yet another reason never to piss off John Lynch.

Team 7: Objective Hell #1, by Chuck Dixon and Chris Warner

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Tags: comics medicine nosebleed john lynch team 7 chuck dixon

Returning to the world of Starship Troopers, the story of the kidnapped psychics continues. As you can see, it’s not a pretty picture.

Starship Troopers #10, scenes by Christian Beranek, Jim Boswell, Cy Dethan, and Scott James

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Tags: comics medicine nosebleed starship troopers what, no casper van dien?

Global Frequency #3 by Warren Ellis and Steve Dillon

No nosebleed this week, but a psychic eyebleed instead. In Global Frequency #3, Lana Kennedy (#884), is brought in to contain an alien meme that has already infected several blocks in New York City. In an effort to save the city, Lana attempts to write her own meme to counteract the alien one, but starts to become affected herself, hence the bleeding eyes.

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Tags: comics medicine nosebleed eyebleed global frequency warren ellis meme

scene from Trinity #37 by Kurt Busiek and Fabian Nicieza; art by Scott McDaniel

D-level villains (and that’s being generous) Punch and Jewelee are used as the focus of Morgaine’s machine to find a new Fool for her villain’s Tarot. The machine identifies the Joker as the perfect Fool — which really isn’t a surprise — but unfortunately neither Punch nor Jewelee survive the process.

SIDE NOTE: Best Punch and Jewelee appearance: Hawk and Dove #18 and #19. Also best Dan Quayle appearance, though WildC.A.T.S. #2 and #3 are close behind.

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Tags: comics medicine nosebleed punch jewelee joker fool

From the world of Johnnie Rico comes this scene of psychic nosebleed (and earbleed and eyebleed), where a formerly enslaved psychic lets the military scientists who kidnapped him know exactly how he feels. And that’s probably more explanation than it needs.

Starship Troopers #9, scene by Christian Beranek and Jim Boswell

And for the record, just in case there was any doubt, the original book Starship Troopers is by far the best version of the story, so take a couple of hours and read it if you never have (or read if again if you’ve already read it). It’s one of the few Heinlein novels I actually like, though his short stories are usually very good — especially the time travel ones (All You Zombies and By His Bootstraps in particular)

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Tags: comics medicine nosebleed starship troopers what, no casper van dien?

A good episode of House with a fascinating premise and some good soap opera and social moments. The medicine was average, but didn’t hurt the episode much.

Nick Greenwald is a successful book editor who, while at a party launching his star author’s latest book, finds himself blurting out truth after uncomfortable truth to those around him. He then develops a nosebleed and collapses.

Nick is admitted to House’s service where the team notes that he reminds them of the classic case of Phineas Gage (a railroad worker who suffered personality changes after a spike was driven through his brain). Nick is showing signs of frontal lobe disinhibition, but there is no sign of a frontal lobe tumor as his head MRI is negative. Thirteen suggests that there may be a tumor hidden in the nasal cavity, but a nasopharyngoscope shows nothing. Next, an fMRI (functional MRI — an MRI that looks at blood flow within the brain) is obtained and reveals an abnormal area in the cingulate gyrus. Thirteen remarks that it’s too near the brainstem to biopsy, then Foreman mentions that it might be neurosarcoidosis (sarcoidosis which affects the central nervous system). Steroids are started to treat the presumed sarcoidosis.

Nick suddenly becomes very short of breath. Foreman states that it’s not his heart because the EKG is normal, so it must be kidney failure, and starts him on dialysis.

The differential now includes systemic sclerosis and chronic lymphocytic leukemia (both of which are quickly dismissed), as well as diabetes, and some sort of “congenital genetic disorder.” Foreman points out that there are too many genetic disorders to test for them all. House has Taub run a glucose tolerance test to check for diabetes, and has Kutner check Nick’s daughter for peripheral nerve damage because she suffers from some ill-defined neurological disorder and he thinks the condition might be inherited. The peripheral nerve test is normal, and Taub reports that the glucose tolerance test was completely normal and never above 120 for the entire night. House now wants to check the thyroid, but before the test can be ordered, Nick develops a fever, coughing, and pulmonary edema. Kutner orders 200MG of furosemide (a diuretic) and 2MG of morphine (primarily a pain killer, it also helps with pulmonary edema).

With Nick’s temperature at 103° (39C), the team now considers infection as the likely cause of his symptoms. Foreman mentions Staph aureus, tuberculosis, and strongyloides (threadworm). Kutner determines that a stray dog is living with Nick’s family and he and House suspect that Nick has developed Weil’s Disease (leptospirosis — an infection caused by the Leptospira genus of bacteria). He is started on doxycycline (an antibiotic) and his condition improves. Kutner and Foreman tell him that while the infection is cured, his brain damage and disinhibition are going to be permanent. Nick wants surgery to remove the damaged area, but they tell him it is too risky. He talks to House, who apparently sees some of himself in Nick, and talks Chase into getting his boss — a neurosurgeon — to perform the surgery. Initially, the surgery seems successful, but then it quickly becomes clear that Nick still blurts out whatever crosses his mind. That’s not all though, as his temperature starts falling dangerously low and he develops unstable ventricular tachycardia (and this is the right time to use the paddles). The arrhythmia is corrected and an echocardiogram is obtained, but shows no structural heart damage. Nick continues to have an abnormal temperature. The differential diagnosis now leans toward cancer, but Foreman rather cavalierly dismisses the idea. He orders a full body scan. This shows a small abdominal aneurysm (dismissed as an incidental finding), a cyst in the pleura (the membrane surrounding the lungs — also dismissed as an incidental finding), and a density in the liver. Foreman suspects this density represnts an ateriovenous malformation (AVM) and that multiple AVMs would explain the patient’s condition. He wants to go forward with angiography with embolization (a test to find and then block off the AVMs).

House is in New York with Wilson, but the team is texting him to keep in touch. In the middle of a conversation about Wilson’s guilt over his schizophrenic brother, House has his Eureka! moment. The glucose tolerance test that was normal should not have been normal because Nick was on steroids, which raise a person’s blood sugar. The fact that it did not rise, combined with the cyst — which is really a fibroma — in the pleura means that Nick has Doege-Potter Syndrome (a fibrous tumor that secretes insulin-like compounds and causes low blood sugar; Kutner mentions human growth hormone, but other similar chemicals can also be secreted). Nick has also developed an autoimmune reaction to the tumor, and his immune system has gone into overdrive and attacked his own body (brain, kidney, heart in this case). Removing the tumor should solve his problems — the medical ones at least.

They’re really weren’t any huge medical errors this week, just the usual hodge-podge of symptoms and diagnoses that really don’t fit. The worst was Foreman’s clueless statement about cancer, so that gets the prize this week. Well, there was also that one scene, but I’ve already spent enough space talking about it.

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

A normal PSA, normal colonoscopy, and normal blood count absolutely do not rule out cancer. Admittedly, colon cancer and prostate cancer are the most common cancers in a man Nick’s age, but there are plenty of other cancers out there (plus there are concerns about how reliable the PSA test actually is).

Diabetes doesn’t really fit his symptoms at all — other than the kidney disease. Of course, it was just an excuse to run the glucose tolerance test.
Speaking of the glucose tolerance test, the patient needs to be fasting, and it doesn’t take 12 hours to run.
It’s true that the steroids should have raised Nick’s sugars, but even a normal patient whose blood sugar didn’t rise above 120 after a hefty glucose load would be unusual.

Brain damage and peripheral nerve damage are two different things. It’s more common to have one without the other than both together.

If Nick’s kidneys are shot and he requires dialysis (a very important fact that was never mentioned again in the show; the dialysis that is, not the kidneys), then even 200MG of Lasix is not going to have any effect.

An MRI of the brain should have shown any nasal cavity tumor, especially one that was eroding into the brain.

Too many genetic disorders to test for them all? But they tested for them all in at least two previous episodes.

House doesn’t like full body scans? Then why does the team order them so regularly.

A cyst is hollow, a fibroma is solid. A scan should be able to tell the difference.

I thought the medical mystery was good this week, it was interesting not only from a medical perspective, but also fascinating from a social perspective. It made me wonder what horrible secrets I might spill. I give it an A. The solution was fairly logical, even if it did require two diagnoses (Doege-Potter + autoimmune). It earns a B+. The medicine was average for the show and I give it a C; it might have scored higher had that one scene been clearer. The soap opera was the best part of the episode. There were good House/Wilson and House/Taub interactions (the squash racket was great), and the patient’s social interactions were like a car crash: painful, but impossible to look away. The soap opera earns a solid A.

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

The scores for this episode’s and last episode’s House Challenge scores have been posted.

The villainous Virtual Bob (yep, that’s his name) is trying to use a virtual reality program to drive Marc Slayton (Backlash) insane. Instead, Slayton turns the tables on him and uses the program to take control of Virtual Bob’s mind.

Seriously — Virtual Bob? Did he really think that was a good name? It’s an MMOPRG gesture, not a name. Frankly, There aren’t really that many awe-inspiring comic book characters who go by “Bob.” There’s Sideways Bob from DV8…and…and….hmmm. Well, there’s Bob the lizard from Grimjack. At least he’s cool.

Backlash #5 by Sean Ruffner, Jeff Mariotte, and Brett Booth/center>

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

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

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

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Tags: comics medicine nosebleed wolverine charles xavier

Recently, I’ve been reading through DC’s Doc Savage comic book series from the late ’80s. It features the titular hero brought forward into modern times and having his usual world-spanning adventures. As to be expected from a character who got his start in the pulp magazines of the ’30s and ’40s, the stories are chock full of improbable — if not downright impossible — science (or should that be Science!). Since I’m a fan of the old pulps, I’m willing to accept these in the spirit of the times.

Sometimes, though, I run across a scene where the science is just a little too mad…

So…the “magnetic ray” exerts a force on the iron in the blood (I can buy that), but this somehow causes the pulse to race, the blood pressure to skyrocket, and then the heart to explode. I’d be interested to know how the hemoglobin in the red blood cells has that powerful an affect on the heart, since normally it exerts exactly zero influence on it. I can’t even conceive of a mechanism how this would work. A racing heart could certainly raise the blood pressure, but other severe problems would occur (severe sudden heart failure, a fatal arrhythmia, a stroke, or a heart attack) long before the heart exploded. This is another example of trying to explain things too much — they should have just left it at “magnetic ray.”

Of course, I do appreciate the fact that I get to add another entry to my “Things Which Cause Nose Bleeds in Comic Books” list.

scene from Doc Savage #12 by Mike Barr and Rod Whigham

From week to week, it seems to vary: Agent Dunham is shown as either very competent or very lucky, and this was an episode favoring luck over skill. Despite that, I thought it was one of the better episodes of Fringe.

The Plot: A passenger on an airline flight notices a sudden nosebleed. He goes to the restroom, checks himself out in the mirror, and then runs a test on his saliva. When the results comes back positive, he is mortified. He rushes out and tries to convince the stewardess and steward that unless he was given some sedatives immediately, everyone on the flight will die. This, unsurprisingly, does not sit well with them. He retreats back to the bathroom where he transforms into a giant porcupine-sasquatch that proceeds to attack the other passengers and terrorize the plane, which shortly crashes into a field.

Agent Dunham and her team are called in to examine the wreckage of the crashed flight. The porcupine-man’s body is found and taken to Bishop’s lab. The good doctor finds “evidence of an extradural hematoma, probable epistaxis” and a glass disc embedded in the victim’s hand (similar to the disc found in the Jell-O Bus episode).

Agent Dunham looks through the passenger manifest and by using Agent Scott’s memories is able to identify the victim. She also identifies a suspicious person among his contacts, Daniel Hicks. When Hicks is brought in for questioning, his nose begins to bleed just like the original victim’s. Before he succumbs, Dunham is able to get a name out of Hicks: “Conrad.” Luckily, Dr. Bishop is there and orders the man be sedated and brought to his lab where he is placed in medically induced coma to slow the transformation. Bishop recognizes that a designer virus is to blame, and is able to concoct a antidote — but isn’t completely sure it will work.

Broyles tells Dunham that Conrad is a mysterious developer of biological weapons that law enforcement agencies have been trying to capture for years. As coincidence would have it, he is due to arrive in Chicago any day now to complete an arms deal for the virus in question.

Seeking information, Agent Dunham goes back into the isolation tank to delve into Agent Scott’s memories. Scott sees her there — though he shouldn’t be able to — and tells her that he was a deep cover agent for the NSA trying to catch Conrad. The two victims of the virus were also deep cover agents. He tells her to trust Hicks.

Dunham orders Hicks to be brought out of his coma and given the antidote. Through an undetectable two-way radio, he is going to guide her through an arms deal with Conrad. She and Peter Bishop fly to Chicago and manage to bluff their way into a meeting with Conrad’s men. Everything goes well until the antidote stops working and Hicks starts to transform again. Bishop has to sedate him to keep him alive. Peter does some fancy verbal footwork, but eventually their deception is exposed. No worries though, because they are able to summon the nearby FBI agents rescue them as well as capture Conrad.

As the episode ends, Dunham goes back in the tank a final time to say goodbye to Agent Scott.

1. Identity Issues
If the victim’s DNA was “completely rewritten,” (Peter’s words) how were they able to identify him through his blood?

2. I Swear, It’s For My Attention Deficit Disorder
I wonder how much dextroamphetamine 30cc is, since Dr. Bishop doesn’t give a concentration. 30cc is a hell of a lot of fluid to inject into somebody — it would hurt like hell, if you were able to get it all in (for reference, 30cc is a shot-glass full of liquid; a usual injection is less than 1cc).

3. Viral Nosebleed Zen
Even if the victim has a bleed around their brain (the “extradural hematoma”), it wouldn’t be able to leak out into the nose unless the skull was also fractured. (FYI: “Epistaxis” is fancy medical talk for “nosebleed”).

4. I Think Walter’s Lab is the Second Level of the Inferno
If I were Walter and autopsying a mysterious porcupine-sasquatch, I would be wearing a mask at the very least.
Walter has the equipment to keep someone safely in a medically induced coma in his lab?
Midazolam is better known as Versed, and is a short acting intravenous sedative from the same family as Valium.

5. The Return of Some Old Favorites
Once again, conservation of mass is an issue. Where did the matter to make all those spines and increased muscles come from?
And I’m not even going to mention the retained-memories from John Scott scenes — well, other than this.

Despite the isolation tank scenes and the return of Massive Dynamic, I enjoyed the episode more than I expected. I thought the arms deal in particular was handled well and gave off a palpable feeling of suspense. I’m giving Fringe a bit of a respite, and moving my Fringe Doomsday Clock back a little: the clock is now showing 11:56.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This scene from Final Crisis #6 provides us with an entire room full of psychics with nosebleeds (not to mention ear- and eyebleeds as well).

I can identify Ms. Martian and Mind Grabber Man, but the rest just seem like generic psychics.

Final Crisis #6 by Grant Morrison and a passel of artists

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A confrontation between un-men Cranius and Janus turns ugly in this scene from the final issue The Un-Men.

Un-Men #13 by John Whalen and Mike Hawthorne

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While attempting to sneak in the back way into Kaizen Gamorra’s fortress, Michael Cray (a.k.a. Deathblow) stumbles across a giant body bank housing hundreds of Gen-active clones to be used as a source of organ transplants.

This causes a reaction from his own Gen-factor (which leads me to believe that he must be a lot of fun at I.O.’s annual Christmas party).

Deatblow #19 by Brandon Choi and Duncan Rouleau

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Another psychic nosebleed from the early WildStorm era. In this scene from Backlash #2, the Daemonite Lord S’Ryn takes over the command of the villainous organization The Cabal from the soon-to-be-late H’Tarh.

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Tags: comics medicine nosebleed backlash daemonite

No longer just limited to comic books, genre movies, and science fiction television, the psychic nosebleed now appears on half-hour situation comedies.

In this scene from the upcoming season premiere of Scrubs, Dr. Cox tries in vain to resist the infectious smile of the hospital’s new chief of staff Dr. Maddox, played by Courtney Cox Arquette.

Thanks to Alan S. for bringing this to my attention.

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Tags: comics medicine television nosebleed scrubs

Threshold is one of those great villains that you love to hate. From his initial appearance in Gen13 through his time in DV8 and later, he didn’t have a single redeeming bone is his body. Sure, you could make excuses: he saw his parents murdered before him, his sister tried to seduce him, his cyborg boss fed him drugs and used him as a sexual plaything…but his malignant personality was too deep to be explained away that easily. He was pure malignant evil.

In this scene, Threshold is fleeing as fast as he can after trying to kill all the other members of DV8 (by blowing up their helicopter over the middle of the ocean) and then attacking I.O. headquarters.

DV8 by Mike Heisler and Al Rio

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I was reading through a stack of old Image comics when I came across this gem of a scene from Backlash #5. Not only has Backlash been captured and chained up (those WildStorm villains did always seem to have a thing for chains), but the evil Mindscape is trying to destroy his mind. Given that the series lasted for another 27 issues, I’m willing to bet that Backlash survived.

Backlash #5 by Sean Ruffner, Jeff Mariotte, and Brett Booth

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I was pretty sure I knew what was going on in Narcopolis — at least for the first three issues — but the farther I read in the last issue, the more I felt that understanding slipping away. When I finished the story, I was pretty sure Delano really didn’t know what was going on either.

Regardless, here’s a nice psychic nosebleed from the climax (so to speak) of the story.

Jamie Delano’s Narcopolis #4 by Jamie Delano and Jeremy Rock

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Tags: comics medicine tv nosebleed narcopolis jamie delano

The Drummer is thrown for a loop when he he caught in a dimensional shift along with the rest of the Planetary team. Unfortunately for him, when you’re tied into the electrical/information system of the entire planet, the change can be quite jarring.

Planetary/Batman: Night on Earth by Warren Ellis and John Cassaday

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In the recent episode “Bloodlines”, Chloe uses her Braniac-ish abilities to access the Kryptonian crystal in an attempt to bring Clark back from the phantom zone. Messy Kleenex is the result.

And no, I can’t explain the all-white eyes that follow the nosebleed. That’s more than I can understand, let alone attempt to explain away.

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Tags: comics medicine tv nosebleed smallville chloe phantom zone

In this scene from Ultimatum #1, Sue Storm uses her force field powers to repel the tsunami of water that had flooded New York City.

It succeeds, but not only does Sue develop a psychic nosebleed, but she also falls into a coma (and the bloody nose miraculously disappears and reappears randomly over the next several panels).

Ultimatum #1 by Jeph Loeb and David Finch

Click on the image for the full scene.

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Miss Sinister daintily wipes the blood from her nose after a failed attempt at breaking Daken’s mental barriers in X-Men Legacy #217 (Mike Carey, Scot Eaton).

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While not as common as the classic psychic nose bleed, the magic-related nosebleed shows up from time to time. This is at least its third appearance in Rex Mundi.

In this scene, Lady Isabelle is using her powers to defeat a cadre of her father’s soldiers.

Her plan works, sort of…

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Because if being forced to listen to Surfin’ Bird for several day straight doesn’t cause psychic damage, I don’t know what does.

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Secret Invasion: X-Men #1, script by Mike Carey, pencils by Cary Nord

If Emma Frost (aka The White Queen) isn’t the most psychic nosebleed prone character, she’s definitely in the top three (I’d put Max Lord and Nate Grey — in his various incarnations — as the other top bleeders).

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Tags: comics medicine nosebleed x-men secret invasion emma frost white queen

For all the io9 readers looking for psychic nosebleeds, start here — that should be enough to keep you busy for a while.

Green Lantern #33, script by Geoff Johns, pencils by Ivan Reis

In this scene, Hal Jordan and Carol Ferris find themselves under psychic attack from the recently empowered Hector Hammond. As you can see, both Hal and Carol develop otorrhagia (bleeding from the ear) from the attack, though Hal also suffers from the classic epistaxis telepathica, better known as the psychic nosebleed.

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Script by Michael Golden, pencils by Ramon Bernado

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

Not to give too much away, but he succeeds.

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Tags: comics medicine nosebleed x-man nate grey shiar

Script by Ben Raab, pencils by Sunny Lee
Today’s example of the psychic nosebleed features Aquaman — or really Aquaboy, as it comes from the Sins of Youth: Aquaboy/Lagoon Man one shot. In this scene, Aquaboy is using his mental-telepathy-with-sea-creatures on the ensorcelled princess Nuada, trying to convince her that she is not an octopus.

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Here’s Vance Astrovik, then known as Marvel Boy, now known as Justice, showing that he’s got a problem with the psychic nosebleeds as well — not to mention a little psychic otorrhagia as well. (These panels are all from New Warriors #3 (first series), by Nicieza and Bagley.)

Justice has got to be one of the most milquetoast and boring of all superheroes. He’s the Chevy Cavalier of the super-hero set. Even Kurt Busiek couldn’t make him interesting.

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Otorrhagia — bleeding from the ear canal — seems to be a recurrent theme in recent comics. It’s been showing up for at least twenty years, but it seems to have become more common lately.

Otorrhagia is not a very common symptom; I see maybe one or two cases a year (and most of those are self-inflicted Q-tip-related trauma). There are a variety of causes, including (in no particular order): basal skull fracture, trauma to the ear canal, tumors of the auditory canal, certain aneurysms, infections of the ear canal, and ruptured ear drums (especially from barotrauma – i.e. pressure).

Comic books add several more causes of otorrhagia:
1. Psychic attack
Not as common as the psychic nosebleed, which it usually accompanies. Here is a classic example of the psychic ear bleed, from the X-Men graphic novel God Loves Man Kills.

2. Sonic bombardment
Another common cause of comic book otorrhagia.
This example is from Cyborg #2

3. Extreme Vertigo.
Poor Invincible, not only does he have so dizzy he can’t think straight, but his ears are bleeding. It turns out the vertigo is caused by an implant in his ear, so that could be the cause of the bleeding (but if that’s the case then the surgeon who put it in should lose his license for sloppiness). Neither can explain the nosebleed he gets a few panels later though.

4. Possession/Reincarnation by a New God.
I’m not sure what the proper term is in this case, but whatever it is, Turpin’s ear is bleeding pretty heavily (from Final Crisis #2).

scene from Rex Mundi #14 (by Arvid Nelson and Juan Ferreyra)
Rex Mundi is set in 1934, but in a world that has seen a history subtly different from our own. Part of the fun of the series for me has been trying to discover exactly where and how the timelines diverge (not to mention the comic features a lead character who is a physician, always a plus in my mind).

But history is not the only thing that is different. In Rex Mundi, sorcery exists, although it is very rare. It also seems to exact a price, as shown here by Isabelle, estranged daughter of the Duke of Lorraine.

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In the recent Venture Bros. episode “The Doctor is Sin,” necromancer Dr. Orpheus is trying to read the mind of the mysterious Dr. Killinger. Not only did Dr. Orpheus’s attempt fail, but he ended up with quite a substantial nosebleed of the psychic variety as well.

You can watch the episode in its entirety here.

This week’s moment of psychic nosebleed zen was suggested by the inimitable PTOR.

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The Differential Diagnosis is one of the key aspects of good medicine. To make a differential diagnosis, the physician takes the patient’s chief complaint and comes up with a list of the possible causes of that problem. This list is then narrowed down by considering the patient’s other symptoms, physical exam findings and lab and radiology results. Eventually, the correct diagnosis is uncovered.

When House and his team try to determine what their patient has by looking at the whiteboard with all the symptoms listed, they are performing a differential diagnosis (a bastardized version actually, since they seem to focus on rare conditions — “zebras” — rather than more likely causes).

For a real world example, if a patient presents complaining of a sore throat, there are at least fifty to sixty possible diagnoses, the most common of which (in my practice, anyway) would be viral infection, allergies, Strep throat, or sinusitis. If the patient also complains of a fever, this makes it likely to be an infection. A cough would make Strep less likely and allergies and sinusitis more likely. Headaches are common with Strep and sinusitis. Chronic symptoms are more likely to be allergies. Symptoms presenting in the dead of winter are more likely infectious. Taking all the symptoms into account, along with a good patient history and a thorough physical exam, would allow the physician to come up with the likely cause of the sore throat (this time of year in the Midwest, probably allergies).

Differential diagnosis can be very challenging in the real world, but imagine how incredibly difficult it must be in a fantasy world where literally anything is possible. Take one of my favorite examples: a nosebleed. In the real world, this probably represents an irritated nose (from an infection or allergies), trauma (including “finger trauma”), or a bleeding problem. In the super-hero world, you also need to add psychic powers, magic powers, possession, and alien abduction, just to name a few. How do you test for those?

Another example comes from this week’s JSA Classified. Wildcat visits one of his old-time boxing opponents and finds him slumped in a wheelchair, virtually comatose. The family tells him that this happened suddenly, on a recent trip to New York. If this were my patient, I would be worried about a stroke, aneurysm, encephalitis, or dementia pugilistica. But not Wildcat, he immediately deduces that his friend was the victim of memory draining villains. That would never cross my mind, but it was the first thing he thought of.

As boring and conventional as it may sometimes be, I think I prefer the practice of medicine in the real world.

Clandestine #2 by Alan Davis and Mark Farmer.
Albert Clandestine uses his powers to attack the mind-controlling Inhuman Tral in this scene from Clandestine #2 (current series). The attack destroys Tral, but is also decimating for Albert, who had used his powers solely for healing before this.

As far as I can tell this is the first, and apparently last, appearance of Tral. So it goes.

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Booster Gold #9 by Geoff Johns, Jeff Katz, and Dan Jurgens.
Frequent contender Maxwell Lord is back in this scene from Booster Gold #9 and telepathically dueling with J’onn J’onzz, the Martian Manhunter. Both have had their share of psychic nosebleeds, so there’s no way this duel wasn’t going to end up a two hanky battle.

This week’s moment of psychic nosebleed zen was first pointed out by Mike Sterling, lord of the Progressive Ruin.

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In this scene from the long-gone-and-best-forgotten Titans series (issue #41 to be precise), Lilith uses her psychic abilities to peer into the mind of an “autistic” child and exorcise the psychic entity that has taken root there. I use the word “autistic” in quotes because while the child was labeled autistic in the comics, she never met any of the criteria for autism; it was just a convenient and inappropriately used label. Titans #41 was by Jay Faerber and Peter Grau. A new Titans series has started, but so far is no better than the last. Lilith remains deceased. All previous Psychic Nosebleed Zen posts Tags: comics medicine nosebleed lilith titans

In the USA Network television series The 4400, a group of people who mysteriously disappeared over the past eight years, all return when a mysterious “comet” brings them to Earth. Most of these returnees (the “4400″ of the title) have developed strange powers.

One of the first to demonstrate his powers was Orson Bailey (played by Michael Moriarity), an insurance broker who disappeared in the 1970s. When upset, he exhibits destructive telekinetic powers that he is unable to control. The use of these powers is accompanied by a nosebleed (and later, ear and eye bleeding as well).

Also of note, the victims of his power also show bleeding from the eyes, ears, and nose — though in one scene, an x-ray of one of these victims demonstrates multiple skull fractures — so they at least show some anatomical justification of their bleeding.

These images are from the pilot episode (not-so-cleverly-named “Pilot“) of The 4400. The first image is from when Bailey is being interrogated by agents from the Department of Homeland Security about a mysterious death, and the second image is when these agents track him down and confront him after a public display of his powers at his wife’s nursing home.

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A classic style psychic nosebleed, courtesy of Atom Eve putting the whammy on two scientists/government agents. You know how hard it is to get bloodstains out of Kirby tech?

Invincible Presents Atom Eve #2 is by Benito Cereno and Nate Bellegarde.

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

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

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

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In Suicide Squad #17, the villainous team Jihad attacks New York City in revenge for the United States sending the Suicide Squad to pre-emptively attack Jihad earlier in the series. In this scene, the villain Badb (named after an Irish goddess) attacks a crowd waiting for the subway.

This scene sets up the CSI: Suicide Squad post from earlier this week.

In this storyline, a reason for Badb’s victims exhibiting a nosebleed is given. It makes no sense anatomically, but at least the attempt is made. Her powers cause a cerebral hemorrhage (bleeding in or around the brain), and this is what causes the nosebleed. Of course in real life, the brain is encased in the dura mater (a thick membrane surrounding the brain) and the skull. There’s no way bleeding in the brain will leak out without a major physical trauma as well — but maybe the anatomy of the head is different in the DC Universe.

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This week’s Booster Gold #8 features the return of the one of the classic psychic nosebleeders: Max Lord. By rescuing Ted Kord, Booster has shifted the time stream so that Max Lord no longer died and the OMACs were never defeated. It’s not a pretty picture.

Mind control and nosebleeds seem to be Max’s defining characteristics now — not that he was ever that complex a character to begin with. Regardless, in celebration of his return to his psychic power abusing ways, here are some Max Lord haiku:

manipulator
likes to play with other minds
needs a red hanky

ran the Justice League
more or less a hero…once
always wears black now

drove Superman mad
psychic skills have a down side
nose goes drip drip drip

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In this scene from the final non-apocryphal Durham Red storyline (“The Empty Suns”), the mutant priest Father Syte gets psychically attacked by the grandaddy-of-all-evil-mutants, the Offspring. It’s not a pretty picture — no lack of Self Esteem here.

Durham Red is written by Dan Abnett with art by Mark Harrison. If you’re a United States reader, good luck finding any Durham Red books in the U.S. at anything resembling a reasonable price, though a few enterprising comic shops may have a copy or two stashed somewhere. Amazon UK is another option — though that’s not exactly in the U.S. now, is it? (Truth be told, it’s where I ended up buying the previous volume, Durham Red: The Vermin Stars, because they ahd the best deal, even factoring in shipping)

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Continuing a look at psychic nosebleed in other media besides comic books. Today’s example comes from the science fiction television show Kyle XY.

Kyle XY is an original series on the ABC Family network featuring a pair of genetically altered teenagers: the eponymous Kyle, and his female counterpart Jessi. They both seem to be developing a wide variety of powers, both mental and physical in nature. However, whenever they push their powers, they end up suffering a nice little nosebleed.

Jessi

Kyle

The first scene takes place after Jessi uses her telekinetic powers to cheat at pool, and the second takes place after Kyle uses his powers to heal another character of cancer. Both scene come from Episode 19, Season 2: “The First Cut is the Deepest.”

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I’m finding fewer psychic nosebleeds in comic books recently (or maybe I’m reading the wrong books), but on the other hand, more seem to be making their way into other media, especially television and the occasional movie.

For example, here are couple of psychic trauma/time travel related nosebleeds (and Spoiler Alert, by the way) from a recent episode of Lost (“The Constant” — episode 5, season 4).

George

Desmond

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In this scene from Blue Beetle #2 (current series), Probe, an eyeless1 member of “The Posse”, is trying to read Jamie’s mind, but the scarab is providing too much interference. Or else her piercings are too tight… Blue Beetle #2 is by John Rogers, Keith Giffen, and Cully Hamner.   1And before anybody mentions it: Yes, she’s wearing sunglassess — that’s to hide the fact that she’s eyeless.   All previous Psychic Nosebleed Zen posts Tags: comics medicine nosebleed umbrella academy super-intelligent chimp

I wish I could say with 100% certainty what is happening in this scene, but I can’t. Basically, it seems that Number 5 is suddenly exposed to the horrific memories of the experiments which were performed upon super-intelligent chimp Pogo and — as he says — he “can’t take it.” What you see is the result. This image is from Umbrella Academy #5 by Gerard Way and Gabriel Bá. All previous Psychic Nosebleed Zen posts Tags: comics medicine nosebleed umbrella academy super-intelligent chimp

Both of today’s examples of the psychic nosebleed occur “off camera” but there’s really no doubt as to what they’re discussing. First, in this scene from X-Men #205 (Mike Carey/Chris Bachalo), one of the Sentinel pilots is complaining that whenever he tries to spy on the girl’s dormitory, the “white lady” (Emma Frost, that is), gives him “a stress headache and a nosebleed.” Psychic Nosebleeds are mentioned in an off hand way in Mass Effect (an X-Box 360 science-fiction RPG) when one of the Biotic (i.e. telekinetic) characters is describing his experiences in training. Discussing a fellow trainee, who got in trouble one night at dinner for reaching for a dish instead of using her powers, he remarks that sometimes it’s easier just to use your hands rather than get a nosebleed. All previous Psychic Nosebleed Zen posts Tags: comics medicine nosebleed x-men sentinel mass effect biotic

Another good example of the psychic nosebleed from Xombi, this time from issue #9. In this scene, David Kim (the eponymous Xombi) and his associates have encountered an imprisoned seraphim, who doesn’t so much tell his story, as download it directly into their brain. It’s another one of those “trying to cram too much in the brain” psychic nosebleeds. Here’s the dialogue from the panel: Make him stop! I can’t take it. The whole inside of my body is itching, like it wants to get out of me. My brain can’t process it all. He’s telling us everything at once. If you haven;t had the chance of reading Xombi, it’s really well worth your time and is available cheaply in back-issue bins and on eBay. Skip issue #0; issues #1-21 are what you want. All previous Psychic Nosebleed Zen posts Tags: comics medicine nosebleed xombi john rozum

Thanks for stopping by from the Wall Street Journal Health Blog, and welcome to Polite Dissent, my blog that takes a look at medicine, television, comic books and how they all interact.

Here are some areas of special interest you might find worthwhile reading:

Medical Reviews of House
Medical Reviews of Comic Books
The Comic Book Drug Reference
Comic Book Public Service Ads and “Special Message” Comics
Psychic Nosebleeds (a catalog the increasing common cliche in genre fiction that nosebleeds are a sure sign of pyschic power)

Xombi #4 written by John Rozum with art by J.J. Birch

A great example of the psychic nosebleed from the wonderful but short-lived comic Xombi. In this scene from Xombi #4, the evil surgeon/occultist Dr. Sugarman is using his newly revealed telepathic powers to rip some information from Nun of the Above’s mind. This psychic attack — of course — cause the sister to develop an impressive nosebleed.

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Tags: comics medicine nosebleed xombi john rozum

This week’s example comes from Wasteland #12, a recent issue of the excellent post-apocalyptic comic published by Oni. In a flashback scene, Doc has suffered an apparent cardiac arrest and Abi is able to restart his heart. How she manages this is unclear, and one of the ongoing mysteries of the storyline. This issue does give the reader some clues, though. Like the fact that Abi develops a nosebleed while in the process of miraculously saving Doc’s life. A little suspicious (especially for long time readers of this blog), don’t you think? Wasteland #12 is written by Antony Johnston with art by Christopher Mitten. It’s a well-written series that manages to combine action, political intrigue, and a fascinating (albeit depressing) setting. It’s definitely worth checking out if you haven’t already (and Oni has the first issue available as a free download). All previous Nosebleed Zen posts Tags: comics medicine nosebleed wasteland/a> masquerade oni

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

Worlds Collide was a crossover event between the Milestone universe and the regular DC Universe (primarily the Superman books). In this scene, Blood Syndicate gang member Kwai reacts to the collision of the two universes. These panels are from Blood Syndicate #16, writen by Ivan Velez Jr with pencils by Chriscross. All previous Psychic Nosebleed Zen posts Tags: comics medicine nosebleed blood syndicate kwai milestone worlds collide

In Ultimate Fantastic Four #46, Reed Richards is forced to absorb the memories and emotions of the entire planet. The rest of the team step in to help and — as seen here — it’s Johnny Storm who seems to take the brunt of the psychic trauma.

It’s the “trying to squeeze too much into one brain” cause of the psychic nosebleed, seen not long ago in Kyle Rayner as well. So the next time you’re forced to memorize too much useless information, be careful — or this could happen to you!

Thanks to penciler Pasqual Ferry, it’s probably the most artistic psychic nosebleed yet — almost makes Johnny look like Salvador Dali.

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Tags: comics medicine nosebleed fantastic four johnny storm

From X-Man Messiah Complex Chapter One (Brubaker, Silvestri) comes this scene of Professor Xavier using Cerebra to augment his psychic powers and ending up with unexpectedly bloody results.

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Tags: comics medicine nosebleed x-men xavier

This week’s example of the psychic nosebleed comes from the recent X-Men #204, where the mutant precog unimaginatively named “Blindfold” has what can only be described as a really bad premonition.

Script is by Mike Carey with art by Mike Choi.

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Tags: comics medicine x-men

More Poison Candy. This is Suzi, who just wants to go home.

Personally, I’d listen to her.

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I mentioned Poison Candy before when it was available as a preview, but now I have my hands on the entire first volume. The story centers on 16 year-old Sam and his friends and family. Shortly into the book, we learn that Sam has contracted SKAR, a mysterious virus that strikes adolescents and is uniformly fatal within a few months. It’s not all bad: the virus also confers psychic powers, but the more the powers are used, the quicker the virus kills the host. A strange benefactor arrives at the door — he offers Sam the chance for a cure, but the cure comes at a high price. And that’s all of the plot I’m willing to give away.

The book is entertaining and solid, and the art — while a little sketchy at times — fits the mood well. My only concern with the book lies not with the creators, but the publishers. TokyoPop is notoriously slow in getting subsequent volumes of its OEMs to the shelves. Poison Candy sets up an fascinating scenario in its last few pages — how long will we have to wait for the next volume?

Anyway, here’s the main character Sam after ending a confrontation with some local gang members.

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Tags: comics medicine manga poison candy

Episode Title: In Which Addison Finds the Magic

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

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

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

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

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

In this third-to-last issue of the 1989 series of Nick Fury, Agent of S.H.I.E.L.D., former S.H.I.E.L.D. ESPer Nina goes mano a mano (or whatever the telepathic equivalent is) with Psi-Borg, a Latverian Hydra double agent (trust me, it sounds much more exciting than it actually is).

Nina starts off with the standard psychic nosebleed, but as the battle becomes more intense, develops psychic ear-, eye-, and mouth-bleeding as well. She’s clearly seen better days.

And apparently her opponent Psi-Borg is a pirate. Or constipated.

Don’t feel too sorry for Nina, though. She gets the upper hand in the end:

PWOOSSHT! Remember that — it’s the sound of a head exploding. I hope you’re taking notes, because it will be on the test at the end of the semester.

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Tags: comics medicine nosebleed s.h.i.e.l.d. pwoossht

It’s not Nick Fury’s psychic nosebleed per se, but one from his eponymous series Nick Fury, Agent of S.H.I.E.L.D. (1989 series). In this scene from issue #16, an evil scientist-wannabe has his mind overloaded when a malfunctioning spy satellite sends all its data directly into his brain.

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Tags: comics medicine nosebleed nick fury s.h.i.e.l.d.

In this example of a psychic nosebleed, a member of the Akira Assassination Corps learns the hard way not to upset Tetsuo. A panel later, his head explodes.

From Akira #32 (Marvel’s Epic edition).

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Continuing the manga theme, this example of a psychic nosebleed comes from TokyoPop’s new title Poison Candy, highlighted in last weeks PW Comics Week newsletter.

To quote from the preview, “In David Hine and Hans Steinbach’s original manga, Poison Candy, a virus infects adolescents giving them telekinetic powers.”
It also seems to give them a need to carry a tissue…

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This example of the psychic nosebleed (and mouth- and earbleed) comes from about halfway through the manga series Akira. Tetsuo is experimenting with drugs that increase psychic powers and has given it to three “volunteers.” Two die almost immediately (an exploding brain will do that two you), but the third survives (but is probably permanently brain damaged).

Scenes are by Katsuhrio Otomo and can be found in Akira #17 (the 1990 version published by Marvel’s Epic Comics imprint )

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Tags: comics medicine manga akira katsuhiro otomo

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

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

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

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Tags: comics medicine nosebleed outsiders

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

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

Today’s example of a psychic nosebleed comes from Mitchell Hundred, star of the comic Ex Machina. In this case, it occurs back when he was still acting as the super-hero the Great Machine and before he became mayor of New York. He’s “maxed out” his powers by controlling an entire jumbo jet.

This scene, from the recent Ex Machine #29 (words by Vaughan, pencils by Harris), was suggested by the Invincible Super Chris.

---

For a big screen psychic nosebleed, check out Fantastic Four: Rise of the Silver Surfer

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Tags: comics medicine nosebleed ex machina fantastic four

This scene is just a small taste of what is occurring (mostly off screen) in the recent Drafted preview issue. Everyone in the city of Jerusalem — and later St. Louis (which strikes a little too close to home) — suddenly suffers what is described as “non-physical head trauma” with symptoms including a buzzing in their heads followed by “hemorrhaging of the ears, nose, and in some cases, the eyes.” The exact cause of the symptoms isn’t named, but highly suggested by the final panel.

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This episode of psychic nosebleed zen was suggested by Marc M.
Tags: comics medicine nosebleed drafted

A couple of firsts in this week’s Psychic Nosebleed Zen post. This is the first time I’ve ever posted a cover that shows a psychic nosebleed. It’s also the first time I’ve posted an image before the comic is actually available. This is the cover for the upcoming Booster Gold #1 comic set to go on sale in August. (It looks like it’s a good thing I posted it now, because Maxwell Lord’s face will likely be obscured by the logo in the final product.) It’s also interesting to note that the psychic nosebleed has now apparently become Max’s defining characteristic — or so one would gather from this cover. The cover is by Dan Jurgens. I’ve blown up the Maxwell Lord aspect so it’s easier to see (and in the process obscured images of Monarch and a blond Question) All previous Psychic Nosebleed Zen posts Tags: comics medicine nosebleed maxwell lord booster gold

In this scene from Wisdom #5 (Cornell, Garcia), psychic Maureen Raven gives her erstwhile kidnapper a little taste of her powers. (Take-home lesson for the week: Never kidnap a psychic or telepath. It never ends well and there’s usually a nosebleed involved somewhere).

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Tags: comics medicine nosebleed wisdom

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

Another look at Maxwell Lord, this time from his penultimate scene in Wonder Woman #219. He may be gloating now, but karma will catch up with him soon. Very soon. Like in about 20 pages.

Wonder Woman #219 was one of the key books leading up to Infinite Crisis. Script is by Greg Rucks and I believe the art is by Ron Randall on this page.

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Tags: comics medicine nosebleed maxwell lord wonder woman

Apparently Nate’s nose bleeds so much that he is completely nonchalant about it when talking with Rahne (Wolfsbane of X-Factor). I also haven’t ruled out the possibility that’s it’s not a psychic headache, as much as a reaction to Rhane’s outlandish brogue. Anyway, that’s some strangely viscous blood. This scene is from X-Man #12 (words by John Ostrander, art by Steve Skroce), when Nate has just been feeling quite Old Testament and parted the sea so that he and Rahne can get a good look at an old shipwreck. All previous Psychic Nosebleed Zen posts Tags: comics medicine nosebleed nate grey john ostrander

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+.

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Tags: television medicine house precocious puberty restrictive pericariditis stroke uveitis

Nate Grey was one of the few who survived the Age of Apocalypse and somehow ended up in the regular Marvel Universe (the others being Sugarman, the “Dark” Beast, and sometimes — via the Exiles — Blink)

In this scene, he is thinking back over the events that led to the collapse of the Age of Apocalypse and he ends up losing control of his powers and destroying a tanker truck. (The line down the middle is from the page seam; this is two-page spread. Now that I’m looking though it, you really didn’t get your money’s worth out of this comic. In a mere 22-pages, there are three two-page spreads and two full-page panels. And it’s not like the other pages had much either, most just had 3 or panels. Some quick math tells me that X-Man #5 delivered an average of just 2.7 panels per page.)

Scene from X-Man #5. Words by Jeph Loeb, pencils by Steve Skroce

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Tags: comics medicine nosebleed nate grey

Nate Grey is the Nathan Summers (a.k.a. Cable) of the Age of Apocalypse. Only, he’s supposed to be more powerful than Cable because he doesn’t have to squander some of his power keeping a techno-organic virus in check. (Though Nate always seemed to get the short end of the stick whenever he encountered Cable, so maybe he’s really not more powerful after all — or maybe just less experienced.) In this scene from X-Man #2 (words by Jeph Loeb, art by Steve Skroce), Nate has just used his power of telekinesis to fly for first time. All previous Psychic Nosebleed Zen posts Tags: comics medicine nosebleed nate grey apocalypse

Make sure to check out today’s installment of Penny Arcade. I think we are witnessing history here: the first webcomic appearance of the psychic nosebleed.

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This example of the psychic nosebleed comes from Factor X #4, one of the comic book “re-imaginings” that took place during the Age of Apocalypse back in 1995. (For those of you who don’t know or don’t remember, the Age of Apocalypse was a glimpse at what the Marvel Universe would have looked like if Charles Xavier had died before he could start the X-Men. For four months in the summer of 1995, all the X-books were renamed and together told the story of this alternate world. On a recent rereading, the stories held up surprisingly well, but the art — with all its ’90s excesses of shoulder pads, pouches, and facial tattoos — did not.)

Anyway, here is the Age of Apocalypse’s Jean Grey giving it everything she’s got. There’s a nose bleed, an eye bleed, and what appears to be a forehead bleed. I have no idea where that last one comes from — she didn’t have it in the previous panels and suffered no head trauma in the meantime. Maybe it’s just miscolored sweat.

Scenes from Factor X #4. Words by John Francis Moore, pencils by Steve Epting

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Tags: comics medicine nosebleed jean grey apocalypse

When Cable encounters his other-dimensional counterpart Nate Grey in Cable #30, the younger — and supposedly more powerful telepath — gets the worst of it. The erstwhile “X-Man” ends up with a psychic nosebleed as well as the less common ear bleed.

Scenes from Cable #30. Words by Jeph Loeb, Art by Ian Churchill

We also get treated to this bizarre nosebleed scene which seems to defy the very laws of time (or at least gravity):

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Tags: comics medicine nosebleed cable nate grey