House - episode 20
As usual, the are spoilers below for this week’s episode of House.
Another week, another episode of House that gave up good medicine for shock value. A young man comes into the clinic and is found to be having a stroke. A CT of the head is normal, except for a metal plate in the jaw from an old accident. Because of this metal plate, the patient cannot have an MRI (MRIs involve powerful electromagnets, and metal is never a good idea in one). Dr. Chase suspects an aneurysm while Dr. Foreman suspects bacterial endocarditis. A vascular study is negative while an echocardiogram shows mitral valve prolapse (MVP). Because of this MVP, the team decides he must have endocarditis and treatment is started. The whole medical aspect gets derailed once it is revealed that the patient is into (gasp!) bondage, domination and asphyxia. Eventually, the medical aspect returns and it is discovered that the patient has neither an aneurysm nor endocarditis, but instead osteomyelitis from the old jaw injury and this is what is causing the strokes.
Both Foreman and Chase were jumping the gun with their diagnoses. Millions upon millions of people have MVP (2-4% of the population) and only a handful of the more severe cases are at risk for endocarditis. While the patient was apparently having some low-grade fevers, Foreman needs to have more evidence before jumping to conclusions. A positive blood culture would be nice, or how about an echocardiogram that actually shows infection on the valves, instead of just MVP. The treatment was a little drastic as well. The antibiotics make sense, but anticoagulants? In terms of a possible aneurysm, with a negative vascular study I seriously doubt any neurosurgeon would take a patient into surgery “just in case” the study was wrong. Neurosurgeons have a high enough malpractice insurance bill as it is without courting disaster. Lest you think I’m just picking on the young doctors, I have problems with House’s osteomyelitis diagnosis as well. Any abscess containing that much pus would show up on the CT scan, even with a jaw plate. I also see no reason an infection of the jawbone would cause a stroke. House’s explanation made no sense. There’s no way that these chunks of “decaying tissue” would end up in the blood stream, let alone in an artery leading to the brain.
The soap opera aspects were well done, with the episode culminating in a date between Dr. House and Dr. Cameron. The exact ending of the date was left open for speculation.
I give this episode a so-so C for the mystery and the first ever F for the solution. The medicine overall earns a paltry D, but at least the soap opera gets a B+.
Reviews (generally more favorable) of previous episodes of House.
May 11th, 2005 at 11:52 am
Add to that Dr. House’s poor hygiene when inserting the syringe (no alcohol swab or gloves) and you start to wonder if that “D” in medicine deserves a minus sign.
May 11th, 2005 at 9:43 pm
I love this show :D I’m always excited on Tuesday because of it!
May 11th, 2005 at 10:21 pm
links for 2005-05-12
Bioethics Discussion Blog: More Satire of Doctors and Medicine:”So What’s Wrong with a Little Fun?” Dr. Cashore was one of my professors at Brown in Pediatrics (tags: Brown Pediatrics professor lecture comedy) Polite Dissent reviews House - episode…
May 11th, 2005 at 11:35 pm
More nitpicks…wouldn’t they have had to go through the consent rigamarole a second time for the jaw operation? I doubt the parents hung around.
Tonight was the first time I noticed the 3 Amigos hanging in the surgical viewing area, not wearing scrubs.
Any possibilities that it was a fat embolism from the osteomyelitis causing the strokes? No? Just checking
For a real question, if they had suspected osteo, would it have shown up on a bone scan despite the plate?
May 12th, 2005 at 8:00 am
Official Comment
A bone scan would have worked fine, even with a metal plate. I don’t think there’s enough fat in a jaw bone to cause an embolus, it’s usually the long bones that cause those.
May 13th, 2005 at 1:14 am
So, um, after they removed Harold’s jaw, what happens? Some sort of implant or prosthetic or something?
May 13th, 2005 at 9:29 am
Official Comment
Prosthethic jaw bone. They would wait until the infection had completely cleared, so it would require a second later infection (and thus he wouldn’t be speaking as clearly as he did at the end of the episode).
May 16th, 2005 at 11:36 am
Add to that Dr. House’s poor hygiene when inserting the syringe (no alcohol swab or gloves)
And Chase doing her procedure (didn’t catch what it was) without swabbing the sites first.
How long would it take to get a patient like that talking again? I’m assuming it’s months to grow the new bone (unless they’re using a plastic prosthetic). How long for the physical therapy?
And besides the fact that an abcess that big would show up on the CT scan, wouldn’t it show up under palpation? Or perhaps from the screaming agony every time the patient moved his jaw?
May 16th, 2005 at 11:37 am
(Er, rather, Cameron, not Chase.)
April 21st, 2007 at 12:25 am
I have chronic osteomyelitis of the jaws and I can tell you that osteomyelitis doesn’t allways present with acute pain, rather low grade fever and dull to aching allmost nondescript pain at times and systemic sub clinical type illness at first. It wasn’t apparent by a CT scan andI had several MDS and dds’s look at it with pus oozing out and my insisting, hey this is osteomyelitis and still it wasn’t recognized before it went chronic. I think the reason for anticoagulants is to increase blood flow in the jaw which is often ischemic in osteo of the jaws. It’s alot more common than most think, often caused by tooth extractions and yeah, garden variety root canals.
May 16th, 2007 at 2:17 pm
I think the dr.House an Dr.Cameron thing was a good way to get people to follow the show cause who doesn’t love a good pairing. I love the show and I love house/cameron and wilson is my favorite character
December 16th, 2007 at 3:32 pm
grow a new bone? they removed the complete left 1/2 of the mandible, i don’t think this will ever grow anew (least the ossification progress has never stopped, but i think, because it ain’t a long bone and he was older than 20 years of age it will never gro new … and what did they do with the muscles inserting on that bone? a little confusing …especially when he started talking …
January 10th, 2008 at 6:57 am
That was the first episode that made me think about the apparent lack of a legitimate medical review behind some episodes. Not being able to notice osteomielitis on the CT! What about the general physical exam and questioning? They would definitely catch an osteomielitis of such severity (they had to remove almost half of the mandubular!).
January 16th, 2008 at 7:30 pm
I’m not a doctor, but If he had an infection wouldn’t he have a fever. From watching House i’ve learned that the obvious sign of an infection is a fever. Is this true or possible?
January 17th, 2008 at 5:40 pm
I just loved this show`s humorous start! With House, Wilson & that weird patient watching T.V in the exam room and having a little fun…
I love this site. I`m a composer, so the medical aspects of the series are a bit far off my knowledge field. That`s why I rely on you fine people to clear out doubts & questions that I am not able to answer. Great job!
House & Cam?? Well… Sounds a little weird, but what the hell!!
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