House - Episode 17 (Season 2)
No sex this week, just a very sick six year-old and the memories of a sick seventy-three year-old. Be warned, there are spoilers aplenty for this week’s episode of House ahead
Ian, a six-year old with bloody diarrhea and ataxia (loss of coordination) is admitted to the hospital. Cuddy thinks it is a case of gastroenteritis (food poisoning or a “stomach flu”), but House suspects it is something more. Twelve years before, a patient of his was admitted with the same symptoms and ended up dying within twenty four hours. That patient — a 73 year-old woman named Esther — developed kidney failure, pituitary failure, liver failure, and respiratory failure before she died. House believed she had a rare condition known as Erdheim-Chester Disease, but he was never able to prove it. With Ian, he sees a chance to redeem himself.
While House believes it is Erdheim-Chester, the rest of the team is not convinced. They also want to consider Listeria infection, leukemia, asthma, or even diabetes. A colonoscopy is performed but shows no evidence of Erdheim-Chester. Just when the team is starting to think that it may only be a case of gastroenteritis after all, Ian develops kidney failure.
The differential diagnosis now includes infection with the bacteria E. coli 0157:H7 (which Chase incorrectly calls HO157) leading to hemolytic uremic syndrome, Goodpasture’s Syndrome (an autoimmune disease that attacks the kidneys and lungs), heavy metal toxicity, and lymphoma. Blood tests for lymphoma are normal, but an MRI of the brain shows a pituitary mass. House starts Ian on a variety of medications in an attempt to ward off liver failure. They seem to work at first, though soon Ian’s platelet count drops and he has trouble breathing, ultimately requiring intubation and mechanical ventilation.
The team is now concerned with sarcoidosis, juvenile rheumatoid arthritis, an autoimmune disease, or Kawasaki Disease. An echocardiogram shows no evidence of the aneurysms normally seen in Kawasaki, but it does show a mass in the heart. House biopsies the heart mass, but the procedure causes a cardiac arrest. Ian is successfully resuscitated, but it takes eight minutes so he may have suffered some brain damage from the lack of oxygen during that time.
Knowing they only have a small biopsy sample to use to save Ian’s life, the team has to decide which three tests they can run because the sample is only large enough for three tests. They are considering histiocytosis (an abnormal increase in the number of histocytes, one of the cells of the immune system), tuberous scelerosis (a genetic disease), leukemia, sarcoidosis, neurofibromatosis, chondrocytoma (a tumor of cartilage tissue), or sarcoma (a muscle tumor). The tests for histiocytosis and tuberous sclerosis are negative. With only one biopsy sample left, House decides he must have been right all along and runs the test for Erdheim-Chester — which of course is positive. The diagnosis has been made, treatment is started, and the ghosts of old failures are exorcised.
An interesting episode with a good mystery. However, the ultimate solution really is not that good a fit for either Ian or Esther. Erdheim-Chester Disease is a rare form of histiocytosis that affects the long bones of the skeleton. Bone pain is one of the first signs, and it has a very distinct appearance on x-ray — something they should have looked for right away. It is most commonly seen in middle aged individuals, and while it has a high mortality, it takes years to run its course, not hours. It can cause kidney, liver, heart, pituitary and lung problems, but it has not been shown to affect the colon or cause bloody diarrhea.
The writers were unusually sloppy about medical terminology this episode. Erdheim-Chester is a type of histiocytosis, but Chase had already run a test to rule out “histiocytosis” — they were probably referring to Langerhans Cell Histiocytosis (”Histiocytosis X“), the most common kind, but it was still sloppy. Cameron mentions “connective tissue diseases” though the team had already ruled out “autoimmune diseases” and the two phrases are synonyms. Of course, that didn’t stop them from mentioning Goodpasture’s Syndrome and Juvenile Rheumatoid Arthritis — two specific kinds of autoimmune disease.
The rest of the medicine was pretty good, though I have a few quibbles about the lab tests (the results were amazing quick, and I’m astonished that their hospital has all the reagents to run these very rare and very expensive tests and doesn’t have to send them out to a specialty lab like the rest of us have to).
In terms of the non-medical content, the poker tournament was a clever set-up and fun to watch. The interactions between House (in person or on the phone), Wilson, and Cuddy were well done. However, this was at least the third or fourth time this season that a random comment from someone (Wilson this time) suddenly makes House realize what the solution to the mystery du jour is. I realize that’s a common cliché in detective fiction, but I find it distracting in a medical show.
The mystery gets a strong B+, but the solution earns a meager C because it really doesn’t fit. This drags the overall medical score down to a high B-. The non-medical content was enjoyable and earns an A as well.
Still want more great medical reading? This week’s Grand Rounds are being held over at Anxiety, Addiction, and Depression Treatments.
April 12th, 2006 at 5:50 am
A couple of episodes ago I remarked upon Foreman’s doing this, too–suffering from a new disorder: Repetitious Dialogue Syndrome! The thing about RDS is that it doesn’t just assume that no doctors are watching; it also assumes no patients, nurses, no medical personnel of any kind, are watching, actually listening to what people say, or that none of us are educated enough to understand RDS when it happens (as it does constantly); perhaps a better name for it would be Repetitive Repetitious Dialogue Syndrome (RRDS)!
The card game was fun, and I loved how he could read Cuddy’s cards just by knowing what she was doing or saying, over the phone, even. Oddly, I found that more believable than his great leaps regarding the medicine. He certainly does know her after all these years. Now if only he’d apply that instinct/knowledge of human behavior to more important personal interactions…
Thank you, again, Scott, for giving us so much information. I am so impressed that you manage to do this in addition to, one presumes, actually practicing medicine. I couldn’t even find histiocytosis in the NIH Medline library (which, while set up for lay people, covers lots of rare conditions), let alone Erdheim-Chester Disease, so it must be pretty rare indeed. And if it first affects the long bones of the legs, it seems really odd that no one even mentioned looking at them via simple x-rays, instead putting such a sick kid through an MRI, which was hard for him, let alone going into his heart to remove tissue for biopsy, nearly killing him. And if the first symptom we saw was bloody stool–actually, NO–it was fresh blood running down the kids legs (I just rewound the tape, and it was drippy blood, not dark and runny stool), not at all the “bloody diarrhea, with some developing coordination problems” the ER doctor described to Cuddy at the poker table. So if Ian was, in fact, bleeding freely, as we saw in the prologue, why wasn’t this more accurately described to Cuddy, and if that’s not something associated with this extremely rare disease, why a) does House think of it, and b) how did the writers come up with blood pouring from anywhere as the first symptom of Erdheim-Chester in the first place? And doesn’t it make the ER doc possibly incompetent to have him describe what we saw as bright red blood dripping down a kid’s legs described as “bloody stool”? I know the difference, and I’m not a doctor. Generally, bleeding from the rectum to the degree we saw in the prologue would be pretty terrifying and indicative of something so serious that it seems truly bizarre that it was suddenly reduced to “bloody stool due to gastroenteritis.” Had the ER doc described what we saw, Cuddy would never have assumed gastroenteritis in the first place, one assumes. And we never heard Ian say he had a “tummy ache”; he told his teacher he had to pee, and said he was “ok,” when asked by the suddenly alarmed (and possibly in labor) teacher. His bleeding down the leg to his socks would have made House’s heightened response more sensible, except that you are saying that this isn’t even a symptom of the disease, so I’m doubly confused. In fact, I’m developing some coordination problems due to my head spinning, so I have to stop typing now.
April 12th, 2006 at 7:57 am
What I want to know is why was a neurologist doing a colonoscopy?
April 12th, 2006 at 8:03 am
Fantastic site. When I watch House I usually pull up wikipedia and start looking up the terms they are using. I went to the show’s page on wikipedia and came across your site in the external links. What a great find.
Question … they blow through a ton of diseases and afflictions, but what are the real world numbers for these things? Are most of them very rare?
April 12th, 2006 at 8:09 am
How badly brain damaged is the boy after oxygen deprivation to the brain for eight minutes?
April 12th, 2006 at 9:02 am
Official Comment
Awi,
I had the same thoughts as you about the “bloody diarrhea.” In my notes, I wrote down “painless rectal bleeding” — I just stuck with the term the show used. That much bleeding should have been a red flag from the very beginning. (Also bloody diarrhea is not common with routine gastroenteritis — it can happen, but is rare. It is usually more indicative of a nasty bacterial gastroenteritis.)
Trench,
Good point. You’ll notice he couldn’t find a source of that copious rectal bleeding, so he’s probably not a very good colonoscopist (and to nitpick, that was a mighty clean colon for someone who didn’t go through a bowel prep).
Patrick,
Most of the diseases they mention on the show are uncommon, but are something every doctor will see at least once in their career. Erdheim-Chester disease is a different story: there have barely been 100 recorded cases, so it’s very rare. (I’ll see if I can find some stats on the other diseases.)
Dominique,
It depends. Children are pretty resilient, but 8 minutes is a long time. There have been near-drowning cases that have had longer episodes of oxygen deprivation and good outcomes, so it’s entierly possible that he’ll bounce right back (but there have been more cases resulting in varying levels of brain damage).
April 12th, 2006 at 9:28 am
Just wanted to say - once again - how much these reviews are appreciated. You might have gone a little easy on them this time, but your reviews are invaluable and I’m constantly referring people to them.
Thanks!
April 12th, 2006 at 10:12 am
The charity event seemed to be held in the hospital itself. Doesn’t seem odd that House was smoking a cigar?
April 12th, 2006 at 11:43 am
See the following link:
http://imdb.com/title/tt0412142/board/nest/40694617?d=40714161#40714161
My usual blurb about how they probably came to get their material for the show and how they goofed up. (I guess in rare cases bony manifestations are not seen).
THE treatment for Erdheim-Chester is not defined. In fact, interferon-alpha has been used with some success. Certainly not with improvement within hours, though.
April 12th, 2006 at 12:23 pm
Official Comment
Good article. I still can’t find any reference to Erdheim-Chester and gastrointestinal complaints or bleeding.
April 12th, 2006 at 1:26 pm
Could anyone shed any light on exactly how the disease “slow played” the medical team? What in particular about the disease made them test for it in a place it hadn’t reached yet, and then be so sure they’d ruled it out?
April 12th, 2006 at 2:06 pm
I was trying to find out what Erdheim-Chester disease and one of the webpages dealing with it mentioned a case that didn’t appear to have skeletal involvement - but they do say it might have been that it hadn’t yet involved the bones; maybe the boy and the old woman would have had skeletal problems if they’d lived long enough?
http://www.ajronline.org/cgi/content/full/174/5/1327 - but it’s pretty far down the page:
“One of our patients had characteristic findings on CT without any evidence of skeletal involvement. Whether this reflects a unique pathologic entity in the lung or whether the patient’s pulmonary findings have simply preceded the development of skeletal abnormalities is unclear.”
April 12th, 2006 at 2:08 pm
I’m also tired of the “seemingly unrelated phrase sparks a revelation” cliché. I saw it over and over on Cadfael, usually followed by Brother Cadfael proving someone’s guilt due to the victim having clover/nettles/some other plant on his tunic. Bah!
April 12th, 2006 at 2:19 pm
Official Comment
David’s post (#8 above) refers to a paper that mentions two cases without bone findings. So it’s apparently not unheard of, though rare (on top of being an already rare disease). I’d still like to see someone find a paper with an association between “bloody diarrhea” and Erdheim-Chester.
April 12th, 2006 at 6:55 pm
Thanks, Scott, re the “painless bleeding” note. I have found that to be increasingly disturbing to me overnight–that they never even expressed concern for the serious things it alone indicated in a young child. If my daughter had ever been bleeding from the back door like that I’d have been pretty upset, yet everyone acted like it was routine for kids to just bleed. Nor did it happen again, nor was any reason for it having started at all ever given. They mentioned his crit was still nice and high, but would it have been after so much free bleeding? Hours had apparently gone by, yet no one mentioned how it had been stopped, Ian wasn’t in a diaper or anything in case it started again. As a Mom, I’d have been very scared, and certainly would have questioned a leap from free rectal bleeding to a heart biopsy. Anyone else notice how often the parents are either accepting of everything being done, no matter how dangerous, or they’re portrayed as hysterical and controlling? None are taken seriously in any case, many are simply “liars” as far as House is concerned, and their permission seems rarely asked, even though they don’t have to let anyone even touch their kid without their fully-informed consent. Many people don’t realize that no one can even touch you or your kid without permission, for any reason, including “life-saving” ones, and House actually takes advantage of that quite openly. If Ian had been my kid, I’d have demanded real answers, or gotten another doctor. I’m amazed sometimes that House just proceeds with extreme tests with total impunity, always vindicated at the end of the episode of course, in situations where I’d never, ever let him touch my kid or myself.
Kitty–I agree, and had actually written so last night, but decided to not add one more complaint! But you’re absolutely right–it’s getting old, and while I realize that one of the marks of “genius” is that ability to connect seemingly unrelated dots, I’m getting tired of House never using any deductive reasoning at all, just always putting things together from unrelated passing comments that others miraculously make just in time to help House save the day. Which brings me to something else–why is it always heroism that seems to drive this show? The episode I liked best was the last one from Season 1, where we got to hear House’s own story–it was human and moving, and while it was still he who diagnosed the problem, it was not presented “heroically” but rather pretty tragically. In my own experience, the best doctors are those who don’t see themselves as heroes, but people who are doing what they’re meant to do, like anyone else on his/her path. The heroic equipment, to paraphrase Forster, is disdained in favor of quiet matter-of-factness. I’d like to see some of that here.
April 12th, 2006 at 6:59 pm
Scott and Trench–not only was that a very clean colon, but it didn’t seem to hurt the kid, who lay quietly when I’ve known adults who couldn’t manage that, especially after bleeding copiously. Shouldn’t he have been rather raw and in pain?
April 12th, 2006 at 7:47 pm
altho only in 1st year med, i usually have heard of most of the disease/symptoms/tests HOUSE & team throws around.
however, this week, most of them were over my head.
and i’m confused. did cuddy see the kid before the party? i actually thought he had some massive rectal bleed (there were two eps before that dealt with that as well) but she just dismissed it as bloody diarrhea. (and the kid had no abdominal pain beforehand?) and the team dismissed EHEC right away (if they have the conjugated antibodies/reagent for the CD61 or whatever in Erdheim-Chester, they most likely could do a verotoxin test to rule it out…)
Rob, I also noticed about the cigar smoking. I know US allows smoking in restaurants and stuff but hospitals? (hahah… i guess the FOX studio backlot is ok)
April 12th, 2006 at 10:57 pm
What is even more amazing is how at the very end.. when the party was obviously over.. House was still there with his cigar and playing poker with Wilson… like they have nothing else to do with their time. Anyway, I love reading these medical reviews, Scott. Since I know nothing about meds. Keep it up.
April 12th, 2006 at 11:07 pm
Cuddy didn’t see the boy until she took the case away from House. Another doctor/nurse/whoever came and described the situation to her while she was playing poker with House and Wilson. House overhears, folds a winning hand, and goes on to the case.
April 13th, 2006 at 2:32 pm
‘House was still there with his cigar and playing poker with Wilson… like they have nothing else to do with their time.’
Sounds like an ok way to unwind after work to me.
April 13th, 2006 at 2:39 pm
Thanks as usual for the great review.
This ep. reminded me of a beef I frequently have with the show - YOU CAN’T DO A HEAD MRI ON SOMEONE WHOSE HEAD IS NOT RESTRAINED. I understand that for the purposes of drama they want the PotW to be able to talk, but c’mon! Give the PotW a damn bite-bar, like you’re supposed to!
I can think of a few fMRI labs that would LOVE to be able to have such little movement artifact problems with their subjects…
April 13th, 2006 at 5:23 pm
You have worn me down with your cunning reviews and I have now watched a whole two episodes of House. I’m assuming that we are way behind on episodes in the UK but I downloaded one new episode and watched the latest one shown here.
Having been brought up on Blackadder it’s initially hard to take Hugh Laurie seriously, particularly since he is often doing apparently absurd things in House. What struck me the most though, was the similarity in structure between the two episodes (which are probably a season apart): patient comes in with mystery ailment which the team then spend the entire episode attempting to diagnose. Is every episode like this?
Having said that, I find the characters engaging and the stories interesting and I’ll try to catch more, even though it’s shown here on a night when I have at least two other things I should be doing at that time.
April 13th, 2006 at 8:36 pm
I’m more forgiving than most people here when it comes to the errors in this show. But even I balked at the painless rectal bleeding being described as “bloody Diarrhea.”
Awi It seemxs a little naive to me to claim that heroism drives the show. They pretty much make it a point every few episodes to remind us that House isn’t a hero so muxh as an antihero (someone who does the right thing for the wrong reason and/or the wrong things for the right reasons). House doesn’t really care about the patient so much as the disease. This point was definitely hammered at us this episode when we hear about all those other times House jumped to this same conclusion and ran a patient through invasive, painful, and embarrassing tests merely so that he could get a chance at solving a years old puzzle that he was already convinced was a rare disease that’s only been observed a handful of times in medical history.
April 13th, 2006 at 9:54 pm
DrObvious–love your posts! And the poker as fund-raiser was just so much better than the old cliche of doctors golfing. If I’m not mistaken, this may be the only doctor-driven show where no one has ever played golf. Thank you, writers!!
April 15th, 2006 at 4:55 pm
Awi- in the “Three Stories” ep where we find out why House limps, he was minigolfing.
April 15th, 2006 at 5:52 pm
I would be only going from memory, and may be 100% wrong, but Ian was already on a ventilator when the biopsy stopped his heart… does that get stopped for the shocks?
r
April 19th, 2006 at 12:30 am
Zach–I remembered that Carmen Electra was mini-golfing, but passed it as it was a fantasy sequence, and not real golf. Unlike real golf, miniature golf is fun, and should always be played in full evening dress, drinking champagne from fluted crystal glasses (but you have to pour the champagne into a 7-up bottle, or else it’ll get taken away by the course “family police”).
April 19th, 2006 at 1:08 am
Zach–Sorry, I missed your “heroism” post. I understand what you mean by House being a sort of anti-hero, but I do feel that the structure of the show, where he always, always, saves the day in the last seconds, against all odds, despite lack of concrete evidence for his “hunches” and, as you mention, his “doing the wrong thing for the right reason,” are all elements of the heroic posture of the show itself, one that reinforces the notion of doctor = omniscient demi-god. Even the notion that Scott has mentioned more than once: “we only have hours to save this person’s life,” or “the drug will either kill or cure her” is part of that “heroic” structure. I have an ER-doc friend, and he’s very much the opposite of House, having also been a surgeon in a war zone. His attitude is very different, very matter-of-fact, and feels he’s just following his own personal calling, not being heroic, and is probably the only doctor I’ve ever heard admit that emergency/war-zone doctors/nurses are often adrenaline junkies who love the rush and do what they do because they just feel it’s their job–something they do because they are good at it, but not because they’re altruistic (please, other doctors, this is not a comment on anyone else’s motives). He also loses patients, while House never does, and that fact alone is one of the things that gives “House” (the show) its “heroic” structure. No one has to agree with me, or with my friend–I just would prefer a little more of his sort of matter-of-factness. I’ve said on another show’s posts that I’m a fully trained homebirth Midwife, and have worked in 3rd-world/no other medical care situations (which was how we met). I am a Midwife because I love it, but also know that I have worked in those situations because I can, fearlessly, and am uncomfortable when others comment on it as “extraordinary”; it’s just what I do. Someone who feels no fear is not a hero; someone who is terrified and does something they’d never ordinarily do, IS, in my own view, a hero. House is fearless. But in any case, it’s the way the show’s presented that draws my (very mild) complaint.
And thanks for the back-up criticising Ian’s rectal bleed being described as bloody diarrhea. We do agree on some things, so put on your tux and join me for Miniature Golf! I’ll bring the champagne.
April 19th, 2006 at 5:41 pm
Howdy House-lovers!
I was VERY disappointed with the “All In” episode. This was the first time that House’s writers let me down, medically.
Erdheim-Chester disease was about as obscure a diagnosis as one could find. When I was finally able to figure out the name,I checked out the disease:
* Only 80 cases have EVER been reported. The disease was first reported in 1930.
* ECD is listed as an adult disease.
* NO satisfactory cure is listed, only some possible treatments. The prognosis is terminal.
Like so many episodes, “All In” had many, many red herrings. These caused the typical 45 minutes of panic/overconfidence/panic we are used to with House. As in too many recent episodes, the writers presented the ultimate diagnosis in a rushed and confused way. Even the name of the disease was hard to figure out from the single reference in the dialog.
To the writers of House– cut your viewers a break and give us some respect. Tell us the name of the diagnosis in enough time and with a enough clarity to understand what’s happening. I don’t mind finding leprosy in Princeton, NJ, if the viewers are in on the diagnostic punchline.
Regards from sunny Phoenix.
May 30th, 2006 at 4:21 pm
With regard to the comments about Colonoscopy with No Sedation, I have had at least 4 over the years with no sedation including one biopsy. There is little sensation, just the stroking of your abdominal wall from the inside. It is all in the mind. It may help that I have Acromegaly.
As observed above, the colon shown was probably far too clean. After being flushed out and eating rice for a day or so, it will look like that.
July 3rd, 2006 at 4:50 am
This was one of the only episodes I have been thoroughly disappointed with medically. Having rushed to look up Erdheim-Chester Disease after the show,and being a paediatrician who has had dealings with children with Histiocytosis, the primary symptoms of this most exceedingly rare disorder were not even mentioned, ie the bone involvement and the eye involvement. Also I was disappointed with the treatment at the end because it was spoken so fast that I didn’t actually catch what they said! And as someone else mentioned, this disorder is not a paediatric condition at all really; so all in all I thought they were greatly stretching the point in this episode altogether. I still can’t get over the flawlessness of House’s American accent when he’s as British as…as British as…well, Blackadder!! I would love to see him just once let his natural accent be used as part of the show, or even have his colleagues be seen to be watching “Blackadder III or IV” on the show!! Wouldn’t it be a hoot?!
July 19th, 2006 at 9:45 pm
Is it just me, or did anybody else notice they were using a defibrillator when the kid had cardiac arrest? I mean, come on! The fact is, if I’m noticing faults in the medicine then there is something severely wrong :-P Maybe they should get a real doctor in as a technical consultant or something.
July 20th, 2006 at 7:06 am
A six year old in a highly specialised hospital and no paediatrician? In USA?
Agree the medicine was even more hilariously hopeless, including the usual lack of any tests which might be simple, cheap and non-invasive before proceeding to colonoscopy & MRI. As pointed out, Smear, Electron micro and toxins from stool. AFTER a colonoscopy and MRI Jason thinks of a examining the blood film and an ESR….
And I would love some of their invisible-until-the-code, non-questioning ministering angels.
At least this time they didn’t let the whole team and family into the MRI chamber.
Um - did I miss anything from an earlier episode, or are the House patients immune from insurance companies protesting that they aren’t going to pay for tens of thousands of dollars of bills for tests and treatment which had no prior approval and in the event were inappropriate? Or at least, probably unjustifiable to the HMO or insurance?
August 1st, 2006 at 9:25 pm
Re: are the House patients immune from insurance companies protesting that they aren’t going to pay for tens of thousands of dollars of bills for tests and treatment…
There is at least one episode that involves House going out of town to justify his bills.
As for this episode, for every disease there are rare exceptions which present with odd or extra symptoms, are there not? Then in a disease that’s only been diagnosed around 100 times in all of history, how can you be sure there aren’t exceptions to the generally observed symptoms? Symptoms like the 24-hour terminus or bloody stool or no bone presentation. Sure the writers might take invoke a little poetic license in presenting two such rare cases for House to treat, but it is a television show. I don’t think that necessarily means it’s bad medicine.
November 27th, 2006 at 7:45 am
I have an ER-doc friend, and he’s very much the opposite of House, having also been a surgeon in a war zone. His attitude is very different, very matter-of-fact, and feels he’s just following his own personal calling, not being heroic, and is probably the only doctor I’ve ever heard admit that emergency/war-zone doctors/nurses are often adrenaline junkies who love the rush and do what they do because they just feel it’s their job–something they do because they are good at it, but not because they’re altruistic (please, other doctors, this is not a comment on anyone else’s motives). He also loses patients, while House never does, and that fact alone is one of the things that gives “House” (the show) its “heroic” structure.
March 27th, 2007 at 1:24 pm
Hi………
You know, I almost fell off my chair when House said it might be Erdheim-Chester Disease.
I have this disease. I am the longest living person with it. (Not sure how much longer I have)
Here is something : My LDL is sometimes as low as 22.
I have been told that if they (NIH) could figure out how that happens, they could start on
a pill to cure people with high Cholesterol.
I want to write more here but, I do not feel comfortable giving out personal identifing info.
But I do have a (short) Blog page at : https://nord.clinicahealth.com
Click on: veiw all blogs and look for the name : groundzerodc
There is a way to contact me, from this web site.
April 5th, 2007 at 11:03 pm
Groundzerodc’s blog can be found here:
http://nord.clinicahealth.com/~groundzero/blog/
200 people diagnosed with the disease since 1930, and one of them posts here. That’s just amazing!
April 10th, 2007 at 6:22 am
[…] On another side, I’ll quote Patrick at Polite Dissent, as saying: Fantastic site. When I watch House I usually pull up wikipedia andstart looking up the terms they are using. I went to the show’s page onwikipedia and came across your site in the external links. What a greatfind. […]
August 22nd, 2007 at 11:59 am
Can somebody answer House’s question - “Can sb explain Kawasaki won’t happen on an adult, other than it won’t?”
November 10th, 2007 at 8:57 pm
I must confirm that I have no evidence for it, but in the physiology-class in my german medical-school (JLU Giessen) it was said, that the cases of cardiac arrests longer than 5 minutes (which is the critical time for the metabolism of neurons (nerve-tissue) to survive without oxygenation), all cases which survived have been of kids drowning in ice water. The low temperature slows down the whole metabolism and so the neurons may last much longer than usually. It’s also been said, that there were flatlines of the EEG (do you call it flatline in the EEG in english aswell? didnt have any medical-english lessons yet) after drownings in icewater which went over to normal EEG waves after a few (or a few more) hours (thats why there have to be 0 electrical activities in the brain for 3 days to confirm braindead over here in germany). I heard nothing about if these children were suffering from braindamages afterwords, sorry. But a cardiac arrest of 8 minutes in a normal tempretured room like shown in this episode is very unlikely to don’t leave any severe braindamages.
Sorry for my sloppy english, been a while since I last had to write in english.
And thanks for your great reviews!
December 14th, 2007 at 7:30 am
If House is so obsessed with this case, why did he spell his patient’s name wrong when he wrote “Esther” on the whiteboard? (As there was no “h” on the file he pulled out of the drawer.) Surely it must be a production flub and not the character’s mistake?
Usually lack of oxygen associated with drowning also results in a corresponding reduction in core body temp which slows the damage? (NM … Grim answered me. And don’t worry …you should see our German.:)
To Janie: There’s a scene where House “fakes” a British accent to justify a late-night phone call (The Socratic Method). And another scene where we see that House’s tivo list features BlackAdder (Clueless), which to my knowledge doesn’t even run in the US.
December 14th, 2007 at 5:40 pm
Grim Reaper: As far as I saw it, the boy was not experiencing apnoe or lacking perfusion of the brain, only very limited perfusion. By the way, if someone is cut off from Oxygen, his brain should be able to compensate that situation for up to 10 minutes (even at normal room conditions), the only problem would be, that he might start suffering inreparable decline of many tissues, especially the heart, which will NEVER be able to act in its life-supporting manner after about 4 minutes of ischemia.
And, sorry for picking on it, but “Poul”s comment is some pointless showing off (”hey, I’m friends with a doctor” and stuff …)
December 15th, 2007 at 4:31 pm
I’m a high school drop-out.
February 21st, 2008 at 11:32 am
I have a suspicion that an important part of this week’s solution was left on the cutting room floor.
The disease normally attacks the middle aged. A lot of the discussion was what do a 70 yo woman and a 6 yo boy have in common. Well they’re both outside the normal range for the acquiring the disease. I rather suspect that someone was supposed to say that perhaps the rapid course of the disease was due to their age and that perhaps even it is more common than suspected because the rapid course of the disease leaves it undiagnosed in the young and old.
April 24th, 2008 at 2:41 pm
Did anyone else catch House referencing 42 as his ‘lucky number’ and wonder if the writers were making a Hitch Hikers Guide to the Galaxy reference there?
Or am I the only one who jumps any time that number pops up ;)
April 25th, 2008 at 12:05 pm
I am marathoning seasons 1-2 of House and had to make a comment here about a tiny inconsistency that bugged me. When House breaks into the Coffee Cove thing. he pulls a drink from the expresso Machine. the problem with that is The First round of grounds from a Machine is POISONIOUS from the chemicals used to clean the machine. House would have been out for atleast the next two days. I know it is small and apparently not many people know it, but since it is a medical show and poisons show up on the list more often that not i was hoping for a touch of Realism (and maybe a small payback for hubris)
July 12th, 2008 at 3:30 pm
Regarding All In episdoe, My nephew was 6 years old when he passed away from Erdheim Chester Disease. His disease progressed rapidly. He lived less than one year.The rapid course of the disease left it diffiuclt to diagnosis. We understand that the writers based some of this epidsode on his case. So there is a touch of realism however the end result was very different.
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