Polite Dissent

Title: In Which Addison Finds a Showerhead

Tonight’s episode tried a little too hard to be clever and suffered for it. Plus, once again, we get a storyline involving Violet and her ex. Enough already! On the other hand, the medicine was a little better.

Dr. Sam Bennett and Dr. Violet Turner
One of Sam’s patients surprised a burglar in her house and is injured and traumatized from the incident. She asks Sam for a pill that will make her forget what happened. As the show progresses, Sam brings Violet in to talk to her and we discover that she was sexually assaulted by the intruder. Sam and Violet, in a miraculous single session, manage to cure the patient’s post traumatic stress disorder (PTSD), and then cause — and cure — PTSD in her husband.
As Violet suggests, there has been discussion that Propranolol (usually used as a blood pressure pill) may ease the psychological effects of the trauma, but will not erase the memories. There was a small study published in 2002 supporting this use of Propranolol, but the numbers were very small and the results did not seem all that impressive to me.

Dr. Addison Montgomery
Maya, Sam and Naomi’s daughter, comes to visit Addison with a friend from school because Maya is scared she may have gonorrhea, a sexually transmitted disease. Maya is tested but shows no sign of the infection. Later, Maya calls Addison frantically because her friend has collapsed in a pool of blood. It turns out that it was not Maya who was sexually active, but her friend, and this friend has a life threatening ectopic pregnancy. Addison rushes the girl into surgery and is able to save her life.
Ectopic pregnancies are pregnancies that occur outside of the uterus. They are most commonly found in the fallopian tube, but can happen anywhere in the abdomen. They can extremely dangerous and life-threatening, particularly as the pregnancy advances.

Dr. Pete Finch
Pete is asked by a former patient of his, a college track coach, to take a look at his star runner. She claims she is fine, but Pete hears wheezing so he brings her into the hospital for a pulmonary/cardiac stress test. During the test, she has a severe bronchospasm (think: asthma attack), and the Pete and the hospital chief of staff tell her that she needs inhaled steroids and “continuous neb.” (nebs = nebulizer, a machine that vaporizes medication so it can be inhaled) She refuses because a big track meet is coming up and she will not be able to compete while on those medications. When neither she nor the coach returns Pete’s calls, he travels to the college track to find her and arrives just in time when she collapses at the end of a race. While in the hospital, it is discovered that she has some “alkaloid” in her system. Pete finds out that she had visited another doctor who had given her some kind of herb, which along with the bronchospasm, nearly killed her and may prevent her from ever competing again. When Pete finds out that the coach is to blame, he slugs him.
The most common cause of bronchospasm is asthma. Exposure to nasty fumes or allergens (including food allergies and bee stings) can also cause it. Severe cases of bronchitis or emphysema can also lead to bronchospasm. If I had a world class runner who suddenly developed bronchospasm, I would wonder why this occurred all of a sudden. Asthma should have shown up much earlier in her career. It’s most likely that she has been exposed to something recently that caused it, and discovering the cause would solve many of her problems.
If the patient is in such severe bronchospasm that she needs continuous nebs, then it would be prudent to actually give her a nebulizer instead of just sitting around about it. Albuterol nebs are usually given every two to six hours in cases of significant bronchospasm. Rarely, they can be given continuously, but only in very severe cases (and these patients have bronchospasm so bad the patient is not able to talk, let alone argue).
The alkaloid she was given would likely be ephedra or ma huang — which would show up on athletic screening drug tests. In fact, any herb that would have an actual beneficial effect on her breathing would show up on a competition drug test. That’s a lot harder to explain away than a prescription medication.