House - Episode 13 (Season Three): “Needle in a Haystack”
A clever mystery on tonight’s episode of House. The medicine wasn’t as good, but House’s wheelchair bet was at least fun to watch. Spoilers below, so watch the episode before you read.
Stevie, a sixteen year-old boy, is making out with his girlfriend when he suddenly becomes short of breath and starts gasping for air. He’s brought to the hospital and admitted to House’s service. According to Foreman, Stevie has no history of trauma, asthma, or allergies. An EKG and echocardiogram are both normal. He does have a bloody pleural effusion (a pleural effusion is a build up of fluid in the membrane surrounding the lung). An x-ray reveals no tumors or pneumonia. The team’s initial thoughts are cocaine or some other recreation drug, or a venous aneurysm.
House orders a venogram, which is negative. Chase and Cameron inspect Stevie’s house only to discover it isn’t his house. It seems he lied to them. He is Romani (Gypsy) and he was brought up not to trust outsiders.
Foreman suspects Stevie has a deep venous thrombosis (DVT - blood clot in one of the veins of his legs), but House still suspects a venous aneurysm. He thinks the leak is so small it didn’t show up on the first test. He wants to thin Stevie’s blood and then try the venogram again (not a good idea. There are nuclear medicine tests that are used to discover small amounts of bleeding — much safer). Foreman decides to go ahead and perform an arteriogram first to look for a DVT. The study shows that blood is going into the liver but not coming out, which Foreman and Cameron interpret to mean that one of the three hepatic vein is blocked. (Strangely, this arteriogram which showed a venous abnormality is never mentioned again, except incorrectly when Foreman states that he performed two venograms). Meanwhile, Stevie is having severe stomach pain so the test is stopped.
The team now considers cirrhosis, disseminated intravascular coagulopathy (DIC), and leukemia, but House rules them all out. They next suspect diseases which could cause a granuloma in the liver (this granuloma would be obstructing the hepatic vein); considerations include tuberculosis (TB) or sarcoidosis. An obstructing liver tumor is also a possibility. House orders a CT, MRI (to look for granulomas and tumors), sputum culture (for TB), and an ACE level (which is usually high in sarcoidosis).
The MRI shows what appears to be a granuloma in the liver, so the team shifts their focus to Wegener’s Granulomatosis. Foreman wants to perform a liver biopsy, but House tells him to go ahead and start cyclophosphamide to treat the Wegener’s.
In the meantime, Stevie’s parents have arrived and are causing a commotion. They are redecorating his hospital room and serving him traditional Romani herbal soups. In the middle of a scene between Foreman and the parents, Stevie again complains of severe pain. Foreman pulls back the blankets to reveal a large amount of blood in his groin. It turns out that while his liver seems to have improved, his bladder has now started hemorrhaging. House wants to start FT-28, an experimental drug not approved for Wegener’s, but Stevie’s parents refuse the treatment. Foreman tricks them into leaving the room, and then talks Stevie into taking the medication. Before Stevie can take the medication, however, he double over in severe abdominal pain.
Stevie is rushed to surgery where a ruptured spleen is found. Foreman looks at the spleen under the microscope, but can find no evidence of any granulomas. House wants the surgeon to examine the small bowel for granulomas, but he refuses. House enters the operating room himself and examines the bowel, but he can find no granuloma.
The diagnosis of Wegener’s seems less likely now, particularly when the surgeon tells them it wasn’t a granuloma in the liver, but instead some scar tissue. House wants to look at Stevie’s large intestine so the Young Guns sneak in and perform a quick colonoscopy while House distracts the parents. The test reveals the culprit: a toothpick. Stevie swallowed the toothpick at some point in the past. His contortions while making out in the car had driven it into his lung, and then it migrated into his liver, bladder, spleen, and then large intestine. Once the toothpick is removed, Stevie recovers.
I liked the fact that the answer to the medical mystery this time was not some obscure disease, but instead something as simple as a swallowed toothpick. It does fit the symptoms, and Foreman is right that wood does not usually show up on x-ray (but I’m not sure about MRI).
While the solution was clever, the medicine was just so-so. House’s fixation on Wegener’s Granulomatosis was strange since it seemed to come out of nowhere. Sure Wegener’s can cause granulomas in the liver (so then it should have been on the differential diagnosis), but so can TB and sarcoidosis, the diseases they were looking for in the first place. The team also continued to confuse pleural effusion (fluid in the membrane surrounding the lungs) with pleural edema (fluid within the lung). Stevie had a bloody pleural effusion, but a bleed within the lung would lead to blood inside the lung, not around it.
The surgery scene seemed off as well. Never mind the House-barging-into-the-OR scene, that’s passé now. I have some concern about the use of silk suture to ligate the blood vessels as silk is only slowly absorbed and extremely irritating to the body. However, a quick perusal of the surgical literature suggests that silk is still used at times to tie off blood vessels, so I’ll let House off the hook on this one, unless some surgeon knows better. I will point out that anatomically, the small intestine is tethered to the mesentery and a variety of blood vessels; it’s not just sitting out like a giant sausage.
Ethically everything was ludicrous, but since when has House or his team bothered to get informed consent?
Tonight’s medical mystery was a solid B, and the solution was logical as well as unexpected, so earns an A. The medicine wasn’t as good, purely average (for House, above average for most other medical shows), and deserves a C. The character interaction/soap opera between the team members was minimal. Most of this week’s non-medical content was reserved for members outside the team. House got in his “wheelchair duel” — and won in his usual Machiavellian way, but this was primarily a Foreman show. What “soap opera” was present was well done though, and earns a B+.
The previous House review
A list of all prior House reviews
February 6th, 2007 at 11:24 pm
Also, I’d like to point out that Graham’s Law only works for ideal gasses (or real gasses close to ideal gasses), and it does not apply to liquids such as a bleed.
February 6th, 2007 at 11:32 pm
So the symptoms started in the lungs. How? If it punctured the esophagus to enter a lung, that would have caused massive GI bleeding (sort of a Mallory-Weiss tear) and pneumonia from having something unsterile and and unsterile GI tract exposed into lung tissue.
February 6th, 2007 at 11:43 pm
Official Comment
Maurice,
I suspect it punctured the pleura, but not the lung itself since he never showed any actual lung damage, just the bloody pleural effusion. I think is was also stomach-to-lung, but the episode wasn’t clear on any of these points. Regardless, your points are valid. Even a small hole in the stomach or intestine can cause a large problem — particularly if it is a toothpick contaminated with saliva and who knows what bacteria.
February 7th, 2007 at 12:03 am
Long time lurker here. I never post here but I love reading your reviews 8) I know nothing about medicine so its interesting to see what’s accurate and what isn’t. I did like that House was back to his usual self this week (even more than his usual self almost) after last week’s touchy-feely episode.
February 7th, 2007 at 12:09 am
Is FT-28 a real experimental drug, and is it really used for RA and Crohns?? I googled it and found nothing… as someone with RA I like to keep up on these drugs, and this was new to me…
Speaking of, I’m no doctor, but why would they even suggest giving methotrexate to someone with liver symptoms?? I’m on a very low dose and still need blood tests and can’t drink because of the risk to my liver. Are the effects not as dangerous for something short term?
February 7th, 2007 at 12:58 am
In case nobody mentions it, I was highly entertained by the scene in which Chase and Cameron enter the house to look for clues - how many times have we seen that before? - and by the way Chase tries to emulate House’s deductive reasoning, only to have the entire house of cards come crashing down when it turns out they’re not even in the right house.
Knowing nothing about Gypsy (Romani) culture, I found the isolation and paranoia angle very disconcerting, to say the least - aren’t there mainstreamed Gypsies in U.S. society? There must be.
Yes, the toothpick was wonderfully, absurdly anti-climactic. The scene where House is examining the kid’s small intestine like he’s reading an old ticker tape was grooooss.
February 7th, 2007 at 1:14 am
Mmm, loved this episode. I hope we see more of the new doctor - I enjoy it when we meet characters with the ability to take on House with a sense of humor. (Also, it’s nice when the patients are complete idiots, either.) The toothpick was really wonderful. It seems we’re back to Occam’s Razor after all.
(However - what on Earth happened to Foreman’s nurse girlfriend?)
February 7th, 2007 at 1:15 am
…That is, it’s nice when the patients aren’t idiots. Oops.
February 7th, 2007 at 1:19 am
Is it show policy to not name drugs that have no generic equivalent? I’ve never really thought about it before now, but, as far as I can tell, FT-28 is a made-up drug, and there are existent drugs (Etanercept, Infliximab, …) that would serve the same utility in the story. I can’t seem to remember any time they’ve mentioned a drug on the show still under patent.
February 7th, 2007 at 1:30 am
Dr. Scott–
What exactly is an intestine “run?” And what exactly would House been have looking for (A bump, soft spot or a bleed?) when he was feeling through the multiple feet of Stevie’s intestines?
February 7th, 2007 at 1:43 am
Squishy,
I am guessing that the new wheelchair-using doctor and Foreman’s nurse girlfriend have been banished to the same Black Hole of One-Shot Characters. I’d like to be proven wrong, because I think TV shows are stronger when they maintain a strong core of recurring characters. But the nurse girlfriend seemed to exist solely to further the bet storyline from that episode, and the new wheelchair-using doctor seemed to exist solely to further the parking storyline.
February 7th, 2007 at 6:52 am
I happened to catch the mention of the drug FT-28 in this episode and that House said it had already shown success in rheumatoid arthritis and something else. As a young (fairly) person who suffers from palindromic rheumatoid arthritis, I am always interested in any strides forward being made in relation to the disease but I have never heard of this FT-28. Can anyone here tell me more about this drug or direct me to a link where I can learn more? My thanks, in advance.
February 7th, 2007 at 8:28 am
Official Comment
Sorry Dagny and D,
As far as I can tell FT-28 is entirely made up. There is no mention of it that I can find on the web (except here, now) or in the medical literature.
February 7th, 2007 at 8:31 am
Official Comment
Speaking of FT-28, the team made a big deal about how it wasn’t “FDA approved” for Wegener’s — well neither is Cyclophosphamide, that’s a strictly “off label” use.
February 7th, 2007 at 8:51 am
Scott - I’m not sure I heard everything correctly, as my mother and I tend to spend House-watching time alternately half-yelling at the television and then telling each other to be quiet, but I though the issue with FT-28 was that it wasn’t yet FDA approved for anything, though it was in clinical trial stages for rheumatoid arthritis and whatever the other autoimmune disorder they mentioned was. Of course, if it wasn’t approved at all, where did Foreman get the convenient blue pills? There wasn’t any mention of any of the trials being held at PPTH.
February 7th, 2007 at 8:59 am
Aaron - it doesn’t seem to me that they go out of their way to not mention drugs still under patent, or at least, I’ve heard them several times use brand-names for drugs (though not usually ones still under patent) in Very Loud And Emphatic Voices, and then in another episode mention the same drug by its generic name. (I’m thinking specifically of Ativan/lorazepam here, though they’ve also mentioned Ritalin (but not methylphenidate, I don’t think) and, of course, Vicodin.)
February 7th, 2007 at 9:42 am
*Raises hand*
I’m confused. Why didn’t the young man tell the doctors he swallowed a toothpick. He seemed very bright, surely he would have known that swallowing a small, pointy object could be the cause of at least some of his medical issues. Did he not realize he swallowed the toothpick? Is it possible to swallow a toothpick without knowing it? Did he know at the time he swallowed it, but forgot by the time he got sick? Or was not disclosing the toothpick swallowing part of the “not trusting outsiders” thing?
Apart from my medical confusion, I enjoyed the episode. It was a fun change of pace from the excellent, but rather dark, episodes of previous weeks. I hope we see the wheelchair doctor again.
Thanks for providing this site, Scott. As a non-medical person, I walk away from every episode with a list of medical questions, and your review usually answers all of them. I appreciate your time and effort to enlighten the scientifically impaired such as myself.
February 7th, 2007 at 9:54 am
The only thing I can think of is that, if chewing toothpicks is a habit, he may have done it before with no adverse symptoms (though I’d personally be freaking out at the concept), and it therefore never occurred to him.
I suppose it is pointless to be appalled at barging into an OR, unsterile, and sticking one’s hands into a patient’s guts, not after all this time, but it’s still a little disturbing.
I think PPTH could stand to reconfigure the lot a little bit and get more handicapped spaces! Irritating as House’s whining was, having had a mother who got around with a cane until she finally ended up with a walker, the concept of crossing icy parking lots with a cane would be enough to make me nervous, too. Though I guess Wilson’s law and logic comment was on the mark.
I wish the boy could take the internship. I sort of liked him, and think he would have been a fun occasional character to send on snack food runs while the team is brainstorming.
February 7th, 2007 at 10:44 am
I loved last night’s episode. Nice to see House being his usual manipulative self. It was also nice to see that he was wrong about the bowel granuloma. It will be interesting if the researcher-wheelchair bound-female-doctor will show up in future episodes. My only hope is that she does not end up being House’s love interest!!! She bothered me for some reason last night!
February 7th, 2007 at 11:07 am
Oh, pleural. I thought they meant “plural,” as in there were multiple things being effused. This is what happens when social scientists watch doctor shows…
February 7th, 2007 at 11:23 am
Peggy–
It’s perfectly possible to swallow a toothpick and not realise it. My Mom has a good story of when her younger brother did it (forgot to pull the toothpick out of a sandwich), and no one knew until he was getting surgery to remove the thing.
Needless to say, I quite enjoyed the solution to this episode, considering my own familial history with toothpick-swallowing. Heh.
February 7th, 2007 at 11:45 am
I watch House and enjoy it, although the anatomical errors sometimes bug me (They probably bug my boyfriend more, since he gets the running commentary). Last night was the worst I’d seen in a while, in terms of big errors. The whole scene in the surgery room was bad—they hand Foreman the spleen and he looks at it under the scope and sees histology as if it were a really, really thin section, without ever prepping a slide. Then the pile of mesentery-free intestines scene caused me to yell at the tv. I thought I was done until they said the toothpick pierced the *intestinal* (not esophageal or stomach) wall into to his lung. They showed it in cross section, and apparently the kid was also suffering from absent diaphragm…
February 7th, 2007 at 12:03 pm
Good episode. I loved watching Chase’s train of logic until it was derailed. It’s getting a bit old to see him suggest drugs and alcohol off the bat, though. The kid was just too bright. And his comment about empty ring fingers was a cheap shot. How many teenagers pay attention to adults’ ring fingers? Nor was just that enough to deduce that the young guns were loners like House.
February 7th, 2007 at 12:10 pm
I thought the episode was very good. Although, I do have to complain about the consent issues (leaving out the lack of masks, glasses, gown (when House walked into the surgery) that happen in almost all of the episodes.
I am no doctor (or any other type of medical person) but, I did have some MRT training when I was about 15, and unless the laws changed, someone correct me if I am wrong, unless the patient’s life is at stake, you cannot treat them unless they have given consent (or a parent or guardian for kids). So, the bleeds and spleen were Okay to be corrected without parental/guardian consent but, thats it… right?
Other than that, I thought it was a great episode and I like the new research doctor, she seems like a good fit for the show. I like how she ribbed House at the end of the episode about Cutty’s “C’s”.
February 7th, 2007 at 12:17 pm
Not a doctor or anything, but even I noticed the small intestine thing: I remember dissecting a fetal pig in high school, and the teacher told us to measure the intestines. I got a D on that part of the assignment because I had to cut the darn thing in a dozen pieces because the membrane holding it in a little ball was so hard to get out of the way.
and yea: first time posting, and a new fan to the show.
can’t get enough of your commentaries: it’s nice to know what is accurate and what isn’t.
one of the reasons I like the discovery channel doctor shows is because it’s actually real: they just stick a camera in the operating room and let the doctors work. I thought that House was like the rest of the Dr. Dramas in that regard: all the medicine was just technobabble and took a backseat to the story, but I got hooked on House’s natural charm regardless. After seeing your site, it’s nice to know what really works and what doesn’t
February 7th, 2007 at 12:19 pm
Good episode, but I bet those Gypsies stole everything that wasn’t nailed down. House should have had Foreman or someone check to make sure they didn’t walk off with a bunch of supplies.
February 7th, 2007 at 4:48 pm
What did the girlfriend mean by “disgusting habit?” when argueing with the parents? Is using a toothpick considered very disgusting, or did the Gypsies do something else with it?
And it bothered me very much that the girlfriend was not there when the boy was discharged. If he’d leave the person you love just because his family disapproved, he was really as lonely as the ringless young guns. I know that our boy is too young for anything real and lasting, but it still made me sad.
February 7th, 2007 at 5:07 pm
I thoroughly enjoyed last night’s episode. Did anyone notice the bumper sticker on the back of House’s wheelchair? “I’d rather be walking”? I thought it was quiet funny- a classic House display. I also enjoyed the focus on Foreman, his interest in Stevie’s intelligence was refreshing.
February 7th, 2007 at 6:16 pm
The disgusting habit was constantly chewing on a toothpick.
First time commenter. I love House and have since episode one. Im so glad that I found this site because I have always wondered how much of the medicine was true and what wasnt. Great site!
February 7th, 2007 at 6:38 pm
Ok, now that the general concensus is that the drug is made up, I’m with you, Aaron - maybe FT28 refers to TNF blockers? They are a targeted immunosuppressant, and are new (although not experimental). Also, they were giving him pills, and all TNF blockers are injected because they are proteins. So maybe it is all together made up??
To D.Ward - I’m 24 and have had RA for 2 years, as far as I know TNF blockers are the the best new(er) drugs around (I think they were approved less than 10 years ago). Enbrel works great for me but everyone is different… But whenever they mention RA on House I get a little excited, thinking they may give this disease the coverage it deserves. But so far, it’s just been a passing mention, although not quite as cliched as the constant suggestion of lupus. It would be nice if they actually went a little deeper into this subject, as it affects so many people. Of course, I guess it is just not as dramatic as a gypsy swallowing a toothpick.
February 7th, 2007 at 11:08 pm
Check out the New England Journal of Medicine, August 3, 2006 - “A sharp right turn”. It talks about risk factors for toothpick ingestion and how it is diagnosed. Too bad the patient in that case ended up losing his leg from the ingested toothpick!
February 8th, 2007 at 8:20 am
Something I found interesting about this episode is that the solution didn’t come from House. We’ve seen him be obsessive over a solution before, only to find out it isn’t the right one. However, in most cases House comes up with something else at the last second. In this case, his team found the cause by accident–it wasn’t a brillaint last minute realization by House that saved the patient.
February 8th, 2007 at 10:48 am
Anybody else find that the logic that led to the colonoscopy (tic-tac-toe) was a bit silly. It just seemed with all the information up to that point that this test would have been deemed unnecessary.
February 8th, 2007 at 12:53 pm
I have been going crazy searching the internet for FT-28. I was at my gastroenterologist’s office today and forgot to ask him about the experimental drug. I can’t imagine why the show would mention a drug that has worked for Crohn’s Disease if it was made up. I do know that Remicade has been prescribed for RA and works for Crohn’s Disease, but I have never heard of it being abbreviated as FT-28.
February 8th, 2007 at 1:09 pm
Official Comment
House has used made-up experimental drugs before, most notably in Episode 8 of Season 1, so I am not surprised they’d go that route again.
February 8th, 2007 at 4:19 pm
It’d be a real mistake, I think, to think that TV writers are bound by reality. I don’t even want them to be. Even though I’m a laywer, for instance, I recognize that shows like “Law & Order” would be much worse if writers were somehow obliged to show all the delays and details of actual investigations and criminal trials. So while I appreciate Scott’s explanation of the medical facts (or absence of same) underlying each episode of “House,” I understand that writers are happy to sacrifice “realism” for dramatic impact. So while I found myself wondering whether “FT-28″ existed — and looked to this page for the info — I can’t say I *expected* it to exist.
(And the same is true, of course, for the many ways in which House’s team does things that are unrealistic or prohibited. I like Scott showing me how the procedures in a real hospital actually happen, but I don’t think the inconsistencies between reality and the show makes the latter “flawed” in any real sense).
February 8th, 2007 at 4:40 pm
One real problem I have with House (the show, not the man) is that there is no sense of continuity. I don’t necessarily think the show needs long-term arcs (Tritter…) but at least carry forward “lessons learned” from previous episodes. Case and point: Cameron sees homeless guy pass away. We comment on this forum how homeless guy represents House, blah blah, etc. etc. Yet, there’s no apparent change in her actions, their relationship, etc. I’m all for episodes being mostly disjoint, but this is a little too much.
Foreman’s nurse friend anyone?
PS: I can’t believe House is being pre-empted… *AGAIN*!
February 9th, 2007 at 9:17 am
During the surgery, why wouldn’t the surgeon have found the toothpick while removing the spleen? If it was just sticking out of the bowel more than halfway, I would think that the doctors would have noticed something while working in such proximity to it.
February 9th, 2007 at 9:27 am
In the ongoing FT-28 discussion, I think it is made up. My husband has Crohn’s and is on Remicade. The only other TNF blocker his gastroenterologist has mentioned is Humira. Remicade is an IV infusion and Humira is an injection. I don’t think those little blue pills were anything more than made up.
February 9th, 2007 at 12:29 pm
Would the small pleural puncture caused by the toothpick lead to a pneumothorax?
February 11th, 2007 at 1:59 pm
One other thing… When, at the end of the episode, Foreman explains why the toothpick doesn’t show up on the MRI, he says it’s because the “wood absorbs water and becomes the same density as the surrounding tissue.” But MRIs have NOTHING to do with tissue density. MRI used to be called nuclear magnetic resonance, but when they started to use it on people, the medical community felt a need to drop the “nuclear” part of the name so that patients wouldn’t think they’re being irradiated. Of course, they’re not being irradiated. Putting molecules in a strong magnetic field (the “magnetic” part of MRI) causes the nuclei (the “nuclear” part, no longer in the name) of a molecule to flip, and then give off energy (radio waves, actually) when they flip back. These “resonances” vary depending on what atoms are adjacent to the resonating atoms, making it possible to determine just what molecule is being seen. NMRI is great for distinguishing tissues for just this reason, and a toothpick, made of cellulose, should stand out clearly, being nothing like any kind of human tissue. Worth noting that NMRI is an extraordinary scientific achievement. 25 years ago, it would only work on tiny tubes of solution spun in a big magnet. Fast computers and very sensitive imaging technology have made it possible to spin the magnetic field rather than the sample, saving us a lot of dizzy patients. I knew one of the guys who was a pioneer in developing NMRI when I was in grad school at U of MN in the early 80s. A very smart guy.
February 11th, 2007 at 4:23 pm
RE: Foreman’s nurse friend: Didn’t that episode pretty strongly suggest that their relationship wasn’t going to last?
February 12th, 2007 at 9:23 am
@ Zach: Maybe. But I’d like confirmation! :-)
February 12th, 2007 at 7:36 pm
I think your web site is great for people who want information about the medical side of house. I didn’t understand the spleen thing though. It way be different because I am a kid with cancer but I had my spleen removed just before it
ruptured. I have hodgkins lymphoma and I had had pain on the upper left side of my stomach for a long time before my
spleen started to rupture. It seems his pain came on very suddenly.
February 14th, 2007 at 12:02 pm
As a person with crohn’s disease, I too must (unhappily) say that the ‘ft-28′ mentioned in the 13th episode of house, season 3, appears that it must be entirely fictional.
Probably motivated by TNF blockers, which are great, yes, especially remicade, but the mentioned stuff, the ‘ft-28′, it seems as though IT must be entirely fictional, all the same.
Not that the writers shouldn’t have all the creative license they can possibly make use of, they should. But it is uniquely cruel on a medical show known for its (relative) realism to make mention of a fictional new drug (or treatment / etc) for any real medical condition that people really suffer from.
And that cruelty could be easily avoided by putting an extra very brief disclaimer text on the beginning, such as :
” Tonight’s episode of House may include mention of one or more fictional experimental drugs ” .
Not only would it avoid giving real people false hope for a new treatment, but it would also help to preserve
the half decent degree of credibility that House used to have for realism but seems to be losing lately just to be able to pull only half-way good stories out of a hat.
February 14th, 2007 at 12:11 pm
this search finds quite a bit of results on the topic of crohns and immune modulation, so it might interest people (though there is (as far as i can tell) still no reason to think ‘ft-28′ is something real):
http://www.google.com/search?q=immune+modulation+crohns&hl=en
February 15th, 2007 at 9:06 am
I’m a physicist, I know next to nothing about medicin but quite a bit about imaging techniques. A toothpick might or might not show up on a CT or x-ray, but it would show up on an MRI as the wood consists of different tissue than any body part. The resonance frequency would be different and a toothpick is large enough for the resolution of a normal MRI.
February 15th, 2007 at 8:30 pm
Pris, thanks for verifying my thought!
February 16th, 2007 at 12:54 pm
There is no such thing as FT-28. The letters in experimental drug codes are based on the company, and no company uses FT.
February 17th, 2007 at 9:00 pm
THANK YOU! for your comment on the intestine.
I’m a first year med student, and ever since we covered the GI system 2 months ago, I’ve been annoyed everytime I’ve seen the human body depicted as a sausage factory. Our lecturer even took the time out to mention that all those war movies that show this spewing of intestines are medically inaccurate.
Also, the spleen from what I understand is a solid organ, akin to the liver. Is it possible for it to burst? I thought not.
February 18th, 2007 at 10:34 am
Official Comment
The spleen can come close to bursting — it can become swollen and rupture (which, depending on how you want to debate the semantics, may or may not be considered a “burst”.) Usually, this involves trauma, though enlarged spleens have a chance to rupture spontaneously. The classic case is the teenager with Mono who develops an enlarged spleen (a symptom of mono). We always caution them against “contact sports” or anything where trauma can commonly occur, because they have a high risk of ruptured spleens. I saw it happen a few years ago when a particular teenager went against his doctor’s advice because he felt that there was no way he could get injured skateboarding. Some people just have to learn the hard way.
February 26th, 2007 at 9:26 am
Was I the only chap who noticed that the spleen they pulled out came from under the chap’s *right* diaphragm?
February 27th, 2007 at 5:32 pm
Don’t know if i’m right or wrong but i think that a exam that hasn’t been at all mentioned is c-ANCAs.It doesn’t confirm diagnosis by itself but can be a great help.Also biopsy isn’t conclusive in 50% of Wegener’s.I think that treating with CYC without checking the c-ANCAs first is medically wrong…..
March 17th, 2007 at 6:52 pm
About the NMRI thing where the toothpick failed to appear. The contention that the cellulose would be clearly cellulose is not exactly an unequivocal case: Cellulose is composed of glucose subunits while starch includes amylose, unbranched 200- to 1000-monomer chains of glucose, in the same bonding (1,4′ glycoside linkages) with a different isomer (alpha rather than beta). The only difference is the placement of one hydrogen atom, not what is bonded to where, so the MRI difference between cellulose and amylose could be small enough to not be recognised (a basic analogue is whether or not L- and meta-tartaric acid have the same NMR spectrum)…
…but: Wood gets its strength from a mixture of cellulose and lignin, an enigmatic protein that we don’t know much about because it is difficult to seperate cellulose and lignin without destroying the lignin; why wouldn’t they have noticed a suspiciously-sugary needle in the intestines?
March 27th, 2007 at 12:35 am
In August 2005, I went to the ER with vomiting and abdominal pain and elevated white blood count. After xrays and cat scan all negative, a surgeon did exploratory surgery and found a toothpick that had perforated the small intestine, I do not know when or where this happened. Can happen but thank goodness not often.
April 28th, 2007 at 11:36 am
Linda you went to the ER with a raised white cell count?! sorry just a bit of a thing i make sure students understand the difference between signs and symptoms.
As for the episode where the hell was his mesentry when House was pulling through his bowel?
July 21st, 2007 at 2:15 pm
Pretty funny :) House rush in the OR, puts a pair of gloves (no scrub, no clothes) and starts examining the intestines strangely deprived of mesentrium…
One funny thing not mentioned was that the preparats of the spleen were ready in a second :) Like the spleen was just a slide holder.
September 8th, 2007 at 3:16 am
The medicine in this episode was as bad as it could be. Not only the major mistakes of the series, physicians performing MRI and CT. The spleen under the microscope (as mentioned earlier on this site) and the obvious bursting into an operation room. The patient should suffer from a severe peritonitis after the “House surgery”. As a physician from Europe I’m wondering why the collegeaus from the States and Canada are not trying to communicate with the makers of the serie in order to make the medical stuff less unbelievable.
September 30th, 2007 at 7:36 am
This is regarding the comments on the MRI and NMR spectroscopy. Though they ARE based on the same technology, I was under the impression that that the MRI gave spatial information about the specimen (instead of the chemical spectra that NMR spectroscopy output) and that it looks for the signal of water molecules. …so does that mean that the toothpick really wouldn’t have shown up if it did indeed absorb enough water as the surrounding tissue did?
December 17th, 2007 at 6:11 pm
I just found this site, so I know I’m late to comment, but what I found annoying about this episode was that House was right about the handicapped parking space. It is harder to go the extra distance for a cane user than for someone in a power wheelchair. I use a cane myself, and am considering using a power wheelchair. The idea of the safety issue when crossing streets seemed highly odd, since wheelchair users cross streets all the time, so I asked some wheelchair users. Apparently you can get a little pole with a reflective flag to stick up from your chair to make you more visible at normal head height if you are concerned with visibility.
A wheelchair user will need a handicapped spot to have space to get the chair into and out of the car, and a power wheelchair will have a maximum range it can go without recharging, but we’re talking about a few feet, and so it shouldn’t be a particular hardship for her to park further away.
I watched that and thought about comments from wheelchair users about people letting them skip ahead in lines and such and them saying, actually, I’m sitting down comfortably, waiting isn’t that difficult. Obviously, it depends upon why the person is using a chair and if there are any other conditions. But I found it odd she’d get the nearer space without better reasoning being given.
January 26th, 2008 at 8:20 pm
Mildly disappointed that nobody on the show thought that a toothpick poking holes along the GI tract wouldn’t cause sepsis or peritonitis..
I do have a question though, how would the toothpick cause a blockage in the liver? It’s my understanding that a toothpick would be pretty hard-pressed to migrate from the intestinal lumen into the circulation system and then block any of the hepatic triads.. so how did the blockage occur?
February 20th, 2008 at 12:45 am
How come nobody has commented on the incredible migrating toothpick? This thing magically goes from GI tract to lung (or pleural cavity), then somehow down to liver, causing scar tissue (would have taken days to form scar tissue, and how did the surgeon diagnose it? It would not have been apparent on the surface), then to the bladder, then up again to the spleen, causing it to rupture, then again to the colon. It may be nice that we have a simple cause for the medical mystery this time, but frankly I thought this was the worst medical mystery I’ve seen.
March 14th, 2008 at 11:51 pm
Noone caught the mistake during the operating room when they removed his spleen. The microscopic view of the tissue that forman was examining was a histological section that had already been Gram stained. Notice the purple coloring of the cells? No one mentioned that snafu!
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