Polite Dissent

Happy Groundhog Day!
Visions of years past.

yet another image from The Amazing Spider-Man Giant Activity Pad

This one is very easy…nobody better miss it

A low scoring week despite the presence of fan (and writer) favorite lupus.

High scores for this week go to Ledasmomand Chimmie, who both earned 6 points. JockM and Lucy tied for third highest with 4 points, then there were a bunch of 3 pointers, thanks to Lupus.

Overall, after Episode 11 there is no change in the top standings: proudfoot retains the lead yet again and Chi remains in second. Georgie and Justin stay tied for third overall.

Full standings and scores can be found here

House lands the prime post-Super Bowl slot, and it was a strong episode overall. The medical mystery was intriguing, as were the logistical difficulties involved in solving it. There were some strong character moments, and a surprise reveal at the end that I did not see coming.

The medicine? Eh, it was OK. The rest of the show was good though.

Cate is a psychiatrist working at the South Pole on a psychological research project, as well as serving as the physician for the team stationed there. Just after treating another staffer with an injured femoral artery, she develops sudden intense right-sided flank pain, vomiting, and begins gasping for breath. No other physicians are available at the South Pole and evacuation is not an option. Since Cate is an adjunct faculty member at Princeton-Plainsboro Hospital, the Psychiatry Department asks House to treat her. Given her location, all the diagnosis and treatment must be done over webcam, and the medical supplies and tests available at the South Pole are minimal.

The initial differential diagnosis includes appendicitis, gallstone, or kidney stone. House in particular feels she has a struvite kidney stone due to recurrent urinary tract infections (large and jagged kidney stones that form due to urinary infections). She denies any history of urinary tract infections. Her Chem 7 (also known as a Basic Metabolic Panel, or BMP) shows declining kidney function, which House believes proves the existence of a kidney stone. He wants her to take a dose of intravenous Cefuroxime (a broad spectrum antibiotic) to cover any infection. She declines, telling House that there are other people who may need their limited supply more. Her kidney function continues to decline. House continues to believe this is a kidney stone, but she believes it is because of dehydration from the vomiting (and dehydration can certainly alter kidney function tests, though it usually has a very specific pattern); she wants to repeat the test after she’s rehydrated. In the middle of the conversation, she becomes tachypneic (rapid breathing) and develops chest pain. House notices that her trachea is deviated to the left which means that she has a tension pneumothorax, a life threatening emergency. Under his direction, she is able to relieve the tension by performing a needle thoracostomy (basically inserting a needle into her chest to relieve the pressure and allow the lung to re-inflate).

The differential now includes tuberculosis — but her PPD was negative, as was everyone else’s at the South Pole — and cancer in the kidney or lungs. An x-ray of her body shows an enlarged mediastinal node which could be a sign of lymphoma. Unfortunately, it is too deep for anything but a surgical biopsy, and that’s not an option. No other lymph nodes show up on x-ray (but then, x-rays aren’t very good at showing lymph nodes), so House has her perform a detailed physical exam on herself to look for other nodes, closer to the surface. She finds an enlarged node just above the belly button. Under Wilson’s direction, Cate plunges a syringe into it and withdraws about 2cc of a straw-colored fluid. No cancer cells show up in the fluid, but there are signs of inflammation. Unfortunately, Cate now begins having severe left flank pain, identical to what she had earlier on the right.

House suspects an autoimmune disease such as SLE (lupus) or vasculitis. He wants to start her on Prednisone, but she doesn’t want to use the medication unless she knows for sure that it’s an autoimmune condition. Foreman states that the normal test, an ANA, is not available, nor is an older test looking at C3. They can perform an improvised LE Prep (Lupus Erythematosus Cell Preparation). The test result is negative, arguing against an autoimmune condition, but House is still suspicious. Reluctantly, he agrees to Foreman’s plan to have Cate go outside, on the theory that the extreme cold will reduce the inflammation of the autoimmune disease and reduce her symptoms. She is about to comply when she passes out and then slips into a coma.

House, Foreman, and Wilson are now dealing with the station mechanic, as Cate is in a coma. They have him taste her urine to see whether it is concentrated (suggesting a kidney problem) or dilute (suggesting a brain problem). The urine is watery, so the cause of Cate’s coma is likely in her brain, they suspect an elevated intracranial pressure (ICP) or a hypothalamic problem. Under the team’s instructions, the mechanic drills a burr hole into Cate’s skull. This is to relieve any increased ICP. Sure enough, she comes out of her coma shortly after the hole is drilled.

House’s team now considers what condition could cause kidney problems, lung problems, and increased intracranial pressure. The differential includes tumor (already ruled out), bacterial endocarditis, deep vein clots, atherosclerotic emboli or fat emboli. House is intrigued by this last suggestion. Cate was cold during the exam and had left her socks on. When they are removed a broken toe is revealed. This broken bone has been throwing off clots of fat to the kidney, lungs, and heart, causing her problems. The bone is reset and splinted and she should be fine.

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Fat emboli can definitely cause lung problems in the form of pulmonary embolism (clots to the lungs), but I don’t see any way it cause a tension pneumothorax. In terms of the treatment of Cate’s tension pneumothorax, the needle thoracostomy relieves the tension aspect of the pneumothorax, but a simple pneumothorax still remains. Cate needs a chest tube (or if it’s small enough, 100% oxygen — all the time, not just an occasional breath).

That’s not how a percutaneous needle biopsy is performed, and that’s an incredible amount of fluid to get back — it’s a solid tissue structure they’re biopsying, not a cyst. PLus, I find it hard to believe the medical kit wouldn’t contain a local anesthetic such as Lidocaine.

Sending someone with an autoimmune disease or vasculitis out in the cold is not a clever idea. It may reduce their symptoms, possibly, if the moon is right. Or it could cause a bad case of Raynaud’s Disease (a cold-induced spasm of the blood vessels in the fingers and toes. It is common in people with autoimmune diseases and vasculitis).

I can see how a fat embolism in the brain could cause a coma (from causing a stroke), but I don’t know that it would increase the intracranial pressure and cause a coma that way.

How did fat embolism lead to enlarged lymph nodes?

It’s fractures of the long bones (femur, most commonly) that lead to fat emboli. I don’t think there’s enough fat in a toe bone to cause a fat embolism.

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I give the medical mystery an A because it was the best mystery they’ve had in a while. The limitations imposed by the patient being at the South Pole were well done. The final solution fit the big picture (lung, kidney, and brain damage), but missed the specifics (how did clots do all that? And from the toe?) so gets a merely mediocre C-. The medicine was for the most part appropriate, especially given the limitations already mentioned. The final answer is where the medicine fell apart. Still, I’ll give it a B- overall. The Three Musketeers didn’t add much this week, but Wilson and special guest patient Cate more than made up for them. That Wilson-is-dating-who? ending is worth some points as well. A for the soap opera.

The previous House review
A list of all prior House reviews

Challenge scores can be found at the post immediately beneath this one (or click here)

Tags: television medicine house kidney stone cancer autoimmune

A single page PSA ad from Spider-Man and Power Pack warning about the dangers of sexual abuse. Not only is it a standalone PSA, but it also serves as an ad for the Spider-Man/Power Pack comic book I’ve discussed in length a few times before.

This ad was found in Captain American #307 (July 1985), but was pretty ubiquitous in Marvel comics of the mid 1980s.

More PSAs

Tags: comics psa spider-man power pack child abuse

Lots of players earned points this week, but there weren’t any dramatically high scores.

Three people topped the scoring this week with a total of 6 (count ‘em: 6) points: me (finally!), Georgie, and Andrew K.

This propelled Georgie to the top for a last minute upset victory for the season, with a total of 56 points. proudfoot was right behind with 55 points, and Chi was just two point behind in third.

Full standings and scores for the Season can be found here

This was probably the last episode of the season, but if they manage to produce and air any new shows, the challenge will pick up where we left off.

Quite likely the final episode of House in this strike-shortened season. Overall, it was a good episode even if it was another exploring the House-versus-religion theme. While the medical mystery was just moderately interesting (at least initially), the solution was clever, and the medicine mostly correct. Good soap opera too.

Roz is a Hasidic Jew, recently converted, and even more recently married. At her wedding ceremony, she loses control of her bladder, and a large stain of bloody urine appears. She collapses and falls, breaking her leg. She is admitted to House’s team for the evaluation of her condition. Dr. Thirteen reports that Roz’s urine culture was negative (meaning no urinary tract infection) and there is no history of trauma or sexually transmitted diseases. A CT scan was negative for cancer and kidney stones. She reports that Roz’s sodium was low, however, and suggests that Roz may have endometriosis of the bladder. Taub counters that the low sodium may be related to Roz fasting before the wedding, while House posits that Roz may have been exposed to a toxin, carboxylic acid in particular. House agrees to let Thirteen start Roz on treatment for the possible endometriosis (with AIs, i.e. Aromatase Inhibitors) and get a cystoscopy . Meanwhile, he sends Taub and Foreman to search Roz’s apartment where they find no carboxylic acid, but discover that prior to her conversion, she had been a heavy metal record producer. She admits to a history of heroin use, but not for some time. A hair sample is obtained, but the tests are negative. Additionally, the treatment for endometriosis has been unsuccessful and the cystoscopy clean.

Taub suggests Roz may have cryoglubulinemia (abnormal proteins in the blood that thicken with cold temperatures), but House feels she has porphyria (problems in the synthesis of hemoglobin), and her sudden conversion to Judaism suggests the mental problems commonly seen in certain types of porphyria. Roz’s husband considers this an insult, and requests a new doctor. Cuddy agrees with the cryoglobulinemia diagnosis and wants to start her on Indomethacin (a potent non-steroidal anti-inflammatory drug, the same class as Motrin). Meanwhile, Roz has become hypoxic with her oxygen saturation dropping to 85%. This argues against both cryoglobulinemia and porphyria. She is kept on oxygen and her saturation improves. Foreman mentions Wegener’s Granulomatosis, but House now believes it to be Lupus with a hidden heart problem. He orders a stress test. Roz makes it through the test well and has no evidence of heart problems. After the test, she develops sudden leg pain and the team believes that she might have a blood clot. An MRI is obtained, which shows no clot, and an fMRI (functional MRI, which works by detecting increases in blood flow within the brain, and these are believed to represent area of brain activity) is ordered as well, ostensibly to look for subtle signs of a stroke. The fMRI shows activity in her limbic system (one of the emotion centers of the brain) when Foreman is placing an IV (a painful situation) which House believes shows that Roz has masochistic tendencies, but Thirteen discovers she was praying during the IV placement, so that might explain the limbic activity.

As Roz stands up after the test, her blood pressure and heart rate come crashing down. When she sits or lies down, she is fine — she only has a problem when standing (orthostatic hypotension — low blood pressure when standing). She is started on fludrocortisone and ephedrine (two drugs that can be used to treat extreme cases of orthostasis). The differential now includes pheochromocytoma (a tumor that releases high levels of adrenalin and similar compounds), systemic sclerosis (better known as scleroderma, an autoimmune disease), and a heart arrhythmia. An EP study (”electrophysiology study”, which looks for abnormal rhythms in the heart) is ordered, but the results are normal. The suspicion now turns to an autonomic nerve disorder such as Riley Day Syndrome. A thermoregulatory sweat test is ordered, but instead of becoming overheated, Roz becomes hypothermic (an abnormally low temperature) and has a seizure.

Infection is now considered as a possible diagnosis, as is Addison’s Disease (a condition where the adrenal glands do not make enough steroid hormones). Roz is started on Cortisol to test for Addison’s and she starts to feel better (cortisol is a steroid hormone). As Thirteen examine her though, she notices a swollen abdomen and Roz reports that she is starting to feel dizzy. Thirteen quickly realizes that Roz has internal bleeding. Chase (apparently the only surgeon in the hospital this season) wants to perform an exploratory surgery to locate the source of bleeding, but Roz decides to delay the surgery until after she has had a chance to celebrate Shabbat with her new husband, even though it might cost her her life. The differential diagnosis now includes DIC (disseminated intravascular coagulation), hydatid cyst (a tapeworm cyst), volvulus of the small intestine (a twisting of an intestinal loop), polycythemia vera (too many red blood cells in the blood), thrombocytopenia (low platelet count) and even Parkinson’s Disease. During the brainstorming session with the team, House has a sudden revelation and realizes that Roz has a nephroptosis, also known as a floating kidney. Instead of being firmly secured to the underlying tissue, her right kidney is hanging loosely, just supported by a few blood vessels. This explains the blood in the urine, the internal bleeding, and the orthostatic hypotension. The strain this is putting on the right adrenal gland (located on top of the kidney) likely explains most of her other symptoms. The floating kidney was not noticed on the scans because they were all performed with her laying down and it only shows up when she is standing up. Surgery should be able to fix her problem and stop the bleeding.

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I really don’t have too many medical complaints this episode, other than my usual litany of untrained people doing potentially dangerous tests and results comic back to quickly. Now, you’ll notice I didn’t say I had no complaints, just not as many as usual:

Roz didn’t just have a slight bit of blood in her urine, that was gross hematuria. In my mind, that should have necessitated a full bladder and kidney work-up from the very beginning that should have caught the nephroptosis.

Was it just me, or did they seem to keep forgetting about her broken leg? It never seemed to be splinted or cast. She did get to do the arm stress test, instead of the treadmill one, but that seemed to be the only acknowledgment of the broken leg.

I’m not clear on what caused her shortness of breath (that improved overnight) or her sudden leg pain (other than, you know, that fracture thing). Maybe blood loss and anemia led to her shortness of breath, but that much anemia should have been easily noticed on her labs.

They sure like to jump to the big guns early, don’t they? Aromatase Inhibitors. Fludrocortisone. Ephedrine. I’m not saying these drugs don’t have their places, just not first thing.

From what I read, there is some debate in the medical community over how significant a “floating kidney” actually is. All of Roz’s autonomic symptoms (hypotension, low sodium, low temperature, etc) are quite a stretch, especially when you remember that she was lying down when many of them happened.

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The medical mystery was moderately interesting, frankly not something that would I would expect to pique House’s curiositu — I give it a weak B. The medicine was better than it has been recently, though still not without mistakes or unexplained symptoms — another B. I thought the solution was clever and elegant, though the severity of her autonomic symptoms were straining credibility. Still, I give the solution an A-. The soap opera was good and almost — almost – had me liking Amber. It was nice to see Cuddy back to her normal acerbic self, especially when she was talking to Wilson. I also give this aspect an A-.

All in all, not a bad quasi-Season Finale. Not a grand slam, but at least a solid triple.

The previous House review
A list of all prior House reviews

Challenge scores can be found at the post immediately beneath this one (or click here).
I’ve also posted information about next season’s Challenge, for all who are interested…

Tags: television medicine house hematuria endometriosis cryoglobulinemia porphyria autonomic dysfunction nephroptosis

Brenda Starr #4, September 1948

Art from the Brenda Starr newspaper strip, script by Mary Schmich, pencils by June Brigman

One of my favorite science-fiction authors has always been the late Clifford D. Simak who wrote a number of great stories and novels from the late thirties until his death in 1988. I have a pretty good collection of his books, often several editions of the same novel, but the ones published during the sixties and seventies are my favorite. First, they have that “old book smell” that I just associate with good science fiction, mostly thanks to spending a large portion of my teen years perusing used book stores. Second, they all have eye-catchingly surreal covers that just fascinate me. The covers have nothing to do with the actual novels inside, but they are so wonderfully bizarre, they trap the eye and I end up more interested in the book than I would be with standard scene-style covers.

Here are three of his books from that era: Time is the Simplest Thing, Destiny Doll, and my favorite, The Goblin Reservation

Time is the Simplest Thing Crest Books, 1964	Destiny Doll Berkley, November 1975	The Goblin Reservation Berkley, March 1969
All books by Clifford D. Simak, all covers by Richard M. Powers

another one from The Amazing Spider-Man Giant Activity Pad

Which 2 Electros (Electri?) are the same. (Maybe he’s a clone now too…)

In my previous discussion of brains and comic books, I neglected to mention a key concept: The Kryptonian Brain Cell Transplant.

It all starts when Linda Danver’s boyfriend David jumps into a swimming pool to save another swimmer, but strikes his head on some underwater debris, suffers brain damage, and falls in a coma.

Supergirl, of course, realizes that just because “no power on earth” can save David doesn’t mean that no one can. She rushes off to the Fortress of Solitude to talk with the scientists from the bottled city of Kandor, certain that Kryptonian science can save her boyfriend (along the way, she rationalizes that she and Superman only turn to the Kandorians in the direst of emergencies¹). Eminent Kandorian scientist Professor Ron-Kar tells her that only a Brain-Cell Transplant can save David.

The Professor arranges for Supergirl to obtain the Kandorian surgical equipment necessary to perform the transplant (made of Quasi-energy, so that only Superman or Supergirl can use them²). Supergirl first uses the tools on herself to obtain “thousands of super-brain cells”, and then transfers them into David (you’ll also note that the Professor falls victim to the 10% Myth here).

The operation is a success and David survives! Unfortunately, he’s not quite what he appears. Instead of being an ordinary graduate student, he is instead a criminal gang leader masquerading as a graduate student for cover. He’s dating Linda not because he cares for her, but because he thinks she’ll make a good alibi for him (poor Linda/Supergirl, she never could find a good date). He discovers that the brain cell transplant has not only saved his life, but also granted him superpowers just like Supergirl. He puts on a lead mask³, calls himself the Super Scavenger, and robs a bank. Supergirl quickly catches up to him.

They battle, but David’s super powers are only temporary (much like Superman’s blood transfusions), and Supergirl is able to capture him and turn him over to police. But there goes her date for the weekend…

This medical case study comes from the the physicians at the Vandyre Clinic, Kandorian Professor Ron-Kar, and Supergirl #4 (by Bates, Saaf, and Colletta)

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Notes:
1. This is a little ironic coming from Supergirl who seems to call on Kandor for help every other issue. She has an awful lot of dire emergencies — most of which seem to revolve around boys.
2. Which doesn’t explain why the Kandorians have them or how they use them since they don’t have super powers.
3. He wears the mas so Supergirl won’t be able to figure out who he is. While she may be unable to see through the mask, she is able recognize David’s watch. Today’s take home lesson for would be super-villains: avoid over-accessorizing.

Tags: comics medicine brains supergirl transplant kandor

Apologies for the lack of a post last night, but there was a slight incident involving an overexuberant pet cat, her claws, and my eye, which necessitated a trip to the ER. Nothing serious — vision is fine, and within a few days I should be back to normal. In the meantime, however, I give myself 2 out of 10 on the Jonah Hex disfigurement scale:

While sitting in the ER waiting room and exam room last night, I managed to read through the entire Showcase Presents The Flash. (This is not an indictment of the ER — it’s flu season and there is a nasty flu bug going around town so the ER was packed. My injury was relatively minor and I knew there’d be a wait. Scott’s First Rule of the ER: Bring the thickest book you can find — quickly — to read while you wait).

Silver Age Flash stories are always a great read, but there were more than a few stories inside that sent my medical and scientific senses a-twitching:

First, Flash #105 (by John Broome and Carmine Infantino).

I’m sorry Mirror Master, but the speed of thought is not faster than the Flash. “Thought” is a biochemical process and as such is subject to the laws of science. Nerve conduction along and between neurons is not faster than the speed of light, in fact according to this neuroscience page (mainly about transmission of pain and touch sensations, but the same principles apply), nerve conduction tops out at a few hundred miles per hour, much slower than the speed of light (roughly 186,000 miles per second hour). Flash, on the other hand, can run faster than the speed of light — much faster than any nerve or thought.

Now if you want to get all philosophical in your definition of “thought” and claim that it is not subject to the laws of science, remember that thought must be put into action, and muscles do obey the laws of science.

Next, let’s take a look at Flash #115, particularly the story “The Day the Flash Weighed 1,000 Pounds” (again by John Broome and Carmine Infantino):

Barry Allen, who is 6′1″ according the statistics I could find, weighs 195 pounds. This gives him a Body Mass Index (BMI) of 25.7 (which on a side note, technically makes him overweight, and other than this issue of the Flash, Barry has never been drawn as anything but skinny).

Now how about this 1,000 pound Flash? He has a BMI of 131.9. Remember that anything over 30 is considered obese and over 40 morbidly obese. Personally, I’ve never seen anyone this heavy. Superhero or not, I don’t think he’d be able to move with that much weight on his frame. (According to a quick Google search, the world’s heaviest man weights 1234 pounds and is barely able to move).

How did the Flash lose all this weight by the end of the story? He climbed into a commercial-sized potato dehydrator and sweated out all that extra weight. Seriously. File this under “do not try this at home” (it’s dangerous and anyway, it wouldn’t work).

Finally, here’s some technobabble from Captain Cold:

Don’t worry Infectious Lass, you won’t spend Valentine’s Day alone! All you need to do is use one of these Legion of Super-Heroes Valentine’s Card, and any man will be yours, guaranteed*!

*Guarantee valid only in the 30th and 31st centuries. Void where prohibited by law or retcon.

Previous Legion of Super-Heroes Valentines:
♥2007
♥2006

Other Valentines Cards:
♥The Legion of Doom
♥The X-Men

Coming soon: Entirely inappropriate Spider-Man Valentine’s Day Cards!

The official start of the 2008 NASCAR season, the Daytona 500, is this weekend, so I thought it would be a good idea to look at issue #2 of the NASCAR Heroes comic book.

I believe this second issue of NASCAR Heroes is actually slightly better than the first one, but that’s not really saying much. The story picks up right where the first issue left off. Dashiell James, a lowly janitor, and his friends of Team Flatrock were caught in a mysterious explosion caused by the evil rocket scientist and top NASCAR racer Jack Diesel (yes you read that right, not only is Diesel NASCAR’s #1 driver, but he’s also a rocket scientist). The mysterious radiation from this explosion gave everyone involved super-powers. Dashiell uses his powers to become the mysterious masked racer “Jimmy Dash” and he and Team Flatrock have become Diesel’s biggest competition.

Most of the book is taken up by various races between Diesel and Dash which all follow the same pattern: Diesel uses his super-powers in an underhanded way to attack Dash and his car, yet Dash somehow manages to beat him in the end. For instance, Diesel — while driving at competition speeds — leans his entire upper body out of his car window and physically tears a chunk of Dash’s car away and rips through an oil line, or maybe it’s a brake line. Regardless, Dash is able to bring his car down pit lane and stop it with feet through the floor board, a la Fred Flintstone. His team manages to fix his car with some bodywork and a new belt for the water pump (how that fixes brakes or an oil line, I don’t know). Dash and his car race back to front but this time Diesel shoots a laser beam from his eyes at them. Luckily, Dash is ready and raises a mirror he has prepared for such an occasion and reflects the laser back at Diesel (yes, his reflexes are apparently faster than light). Using this distraction, he is able to win the race.

I’m beginning to think that the poor logic in the book’s storytelling may actually cause brain damage. As far as you can tell by the story, there are only two cars at each race. Never mind the other 41 cars, drivers, teams, track personnel, NASCAR officials, reporters or sponsor representatives that should be there. Somehow the NASCAR officials never seem to notice such minor things as laser beams, spurting oil, or drivers leaning out the window and never ever call a caution. The most spectacular display of illogic occurs toward the end of the comic when Diesel holds Team Flatrock’s owner Astor hostage at a local auto salvage yard; he tells Jimmy Dash to meet him there alone. To his credit, Jimmy comes with the other members of the team. On the other hand, they all come in the team’s single race car: a not-road-legal race car that can barely manage to hold one person yet somehow manages to carry the entire team. Plus, you know, it’s an auto salvage yard — bringing a race car there is just asking for trouble.

The art tries, but is mostly amateurish (one problem may be the fact that the credits list one main artist plus four additional “guest artists”). It’s not bad, but it needs to be a lot better in what is supposed to be a professional comic. The layout and blocking are good and show an understanding of the comics medium, but the colors need a lot of work and always come off looking flat.

On the plus side, there are imaginative use of sound effects. In this issue, we get a Bzannnnng, a bunch of Krimps, several Ftashes, a Zavf, plus the ever reliable Wump, Klang, and Klunk. The paper quality is nice, too.

The main problem with this comic is the same thing that I mentioned after reading the first issue: it doesn’t know what it wants to be. Is it a NASCAR comic for comic fans, or a comic book for NASCAR fans? It tries to be both, and succeeds at neither. The story is too over the top and too cliché to appeal to modern comic readers (and it’s probably even too much for Silver Age readers — and that says a lot). On the flip side, the racing scenes and background are too far removed from the reality of the sport to appeal to the NASCAR fan.

Tags: comics nascar nascar heroes

Looks like a pretty normal x-ray of the rib cage to me — nothing dangerous about that. Except that it doesn’t show the lungs at all, so either it’s horribly under-exposed, or else the patient has the dreaded Lead Lung Disease. That must be it — and it all makes sense now.

(Or the doctor is incompetent, or he is lying to Nurse Crane because he wants her all for himself)

Speaking of Nurse Betsy Crane, it appears we were once engaged.
That would explain a lot.

With the U.S. Navy scheduled to shoot down an errant satellite later this week, I thought this would be a good time for a space-related PSA. This Captain America/Young Astronaut Council ad is from the back pages of Captain American #307, an otherwise forgettable issue featuring Nomad and Madcap.

The Young Astronaut Council was formed in 1984 to get children interested in space and science. According to their article on Wikipedia, they are “the largest youth aerospace organization in the world” (though I’m not sure that’s a title with a lot of competition). As far as I can know, the Young Astronaut Council is still in operation today, though you couldn’t tell it from their website, which I seem to be unable to access.

Click on the image to the right for the full ad.

For another relevant PSA, check out this one from Airboy #22 (May 1987) which takes an unkind look at the SDI program (”Strategic Defense Initiative” — i.e. the “Star Wars” program — a plan to shoot incoming enemy ballistic missiles out of the sky).

More PSAs

Tags: comics psa space captain america young astronaut council sdi

The Set-Up: Derek Reese, John Connor’s uncle, has been shot and severely wounded. He needs a transfusion, but since he’s a wanted man Sarah doesn’t want to take him to the hospital and instead elects to perform a transfusion in the kitchen. She offers her blood, but since she is O- and Derek is AB- her ex-fiancé (an EMT) tells her it won’t work; Derek needs an exact match. John offers his blood and it must be a match because we see him a short time later transfusing his blood into Derek.

Though Sarah Connor is blood type O- (known as the “universal donor”) she cannot donate blood to Derek because this is a whole blood transfusion. In a normal transfusion, just the red blood cells are transfused, but in a whole blood transfusion both the blood cells and blood plasma (i.e. the “whole blood”) are used. The blood cells carry the proteins that determine a person’s blood type, but the plasma carries antibodies that react against other blood types. Because a whole blood transfusion deals with both blood cells and plasma (and proteins and antibodies), the donor and recipient blood types need to match exactly or there will be a nasty transfusion reaction.

AB- is the rarest blood type. In the general population of the United States, about 1 person in 167 (roughly 0.7%) are AB-, though blood type distribution can vary greatly by race.

TYPES	DISTRIBUTION	PERCENT
O +	1 person in 3	38.4%
O -	1 person in 15	7.7%
A +	1 person in 3	32.3%
A -	1 person in 16	6.5%
B +	1 person in 12	9.4%
B -	1 person in 67	1.7%
AB +	1 person in 29	3.2%
AB -	1 person in 167	0.7%

The most important aspect of the transfusion seems to have been entirely missed by the writers: since Sarah has blood type O-, that means that she cannot be John’s mother. John gave Derek a transfusion so he must be AB-. That means that he inherited an A gene from one parent and a B gene from the other (A + B =AB). Sarah is blood type O which means that she has neither an A nor a B gene to pass on to John. Blood type O parents can only have A, B, or O children, depending on the blood type of the other parent. They can never have AB children*.

Miscellaneous nit-picks:
That sure was a tiny IV to transfuse 3 units of blood through. It would have taken the better part of a day.
What sort of EMT strolls around carrying a sedative in their bag (and given the small dose needed to work, it must be a controlled substance, such as Ativan or Valium) or has blood typing serum?
A “manual aspirator to drain the lung” — what the heck does that mean? Did he mean a chest tube?

*I guess John could be a spontaneous mutation, or maybe a liver-transplant recipient, but those are both quite a stretch.

♥A previous post on whole blood transfusions

Tags: television medicine terminator blood type transfusion

From the great Kirby and Lee comic Captain America #107, which introduces the villainous Dr. Faustus (a character who encompasses two of my favorite comic book cliches: 1. The evil psychiatrist, and 2. The character whose name should make it blatantly obvious that they’re evil)

Apparently, Supergirl can determine whether this thug is lying by feeling his radial pulse.

I have my doubts about this. First, she has no frame of reference. She’s never seen this lowlife before, let alone checked his pulse to establish a baseline. He may have a naturally slow pulse or be on medications that slow the heart rate. Or he may be an accomplished liar. So what she thinks is the truth may actually be blood pressure medication. Consider the polygraph test — the interviewer always asks “control questions”to learn how the interviewee responds when lying or telling the truth. Supergirl hasn’t done anything like this, so she really can’t know for certain if the thug is telling the truth (plus the polygraph looks at more than just the pulse — and frankly, it’s not that reliable a test).

Actually, the thug’s slow heart rate concerns me. This is a small time criminal who’s just had his car ripped from under him, and then been accosted by the second strongest person on the planet — a well-known do-gooder who wears the fabled “S” on her chest. His heart should be racing and skipping, not steady enough for her to think he isn’t lying. He probably has sick sinus syndrome or is taking too high a dose of his beta blockers.

Scene from Supergirl #1 (1972), script by Cary Bates, pencils by Art Saaf.

In a related bit of trivia, William Moulton Marston — creator of Wonder Woman — was one of the originators of the polygraph, particularly the part about checking the blood pressure to determine when someone is lying.

Tags: comics medicine supergirl lie detector polygraph

I’ve been pointing out examples of bad CPR and emergency resuscitation for several years now, but this one from Superman Family #171 takes the cake (so far, anyway). In the story, Supergirl is knocked unconscious by Black Canary’s “canary cry” and thrown into a river to drown. Batgirl jumps in and drags Supergirl to shore. She starts to perform rescue breathing on Supergirl but quickly gives up. So she drags her to the nearest car, uncaps the tire valve, and shoves it in Supergirl’s mouth. Miraculously, this restores her breathing to normal.

This is so over the top, I really can’t add anything except to point out that this would never work in real life, so please don’t ever try it (but hopefully you all figured that out on your own).

And finally, for those of you who only speak LOL:

All images from “Cleopatra, Queen of America” found in Superman Family #171. Script by Cary Bates. Art by Curt Swan. Scanned in from Showcase Presents Batgirl, Volume 1.

Tags: comics medicine batgirl supergirl rescue breathing cpr

the final puzzle of this type from The Amazing Spider-Man Giant Activity Pad

Which Venom is different?

This one’s a little trickier, mostly because of the black-and-white-on-newsprint printing method.
To make it a little easier, click here to see an enlarged higher-quality image of the four Venoms in question.

In an exchange transfusion, a portion of the patient’s blood is slowly withdrawn and replaced with donated blood. Depending on the patient and the situation, the transfusion may involve just a small fraction of the patient’s blood, or enough to refill the circulation several times over.

Exchange transfusions are most commonly used to treat severe jaundice in newborns, but they can also be used in critical cases of sickle cell anemia, thrombotic thrombocytopenic purpura, and hemolytic disease of the newborn (a condition caused by a blood type incompatibility between mother and fetus). Exchange transfusions have also been used to cleanse certain drugs and toxins from the body.

A good example of this last use comes in Captain America #377, the penultimate issue of the Streets of Poison storyline. Cap had been caught in the explosion of a methamphetamine lab and the high levels of the vaporized drug somehow bonded with the Super Soldier Serum in Cap’s blood, causing abnormally aggressive and violent behavior. The only way to remove the drug is to perform an exchange transfusion. Unfortunately, this will also remove the Super Soldier Serum as well, rendering Cap powerless. (Don’t worry — the Super Soldier Serum eventually reasserts itself and everything works out well in the end, but that’s a post for another day.)

Comic Book science, of course, takes the exchange transfusion to the next level. For instance, what if a fluid other than blood is used in the transfusion?

In All-Winners Comics #1 (a classic Captain America story), Cap and Bucky face off against an army of “zombies” created by a mad Nazi scientist. These aren’t classic zombies, but instead transients and bums turned invulnerable through an exchange transfusion.

In the more recent Umbrella Academy #4, Vanya is experimented on by the Conductor of the Orchestra Verdammten and has her blood removed and replaced with a dark evil liquid. This transforms her into the villainous La Viole Blanche (aka The White Violin) who vows to destroy the rest of the Umbrella Academy…as well as the entire world.

The take home message is that exchange transfusions serve an important function in severe disease, unless you’re in a comic book and something other than blood is used. If that’s the case, run far far away as fast as you can.

Other Comic Book Diagnoses:
Frozen Solid
Brains! Brains!
Hypertrichosis
Xenografting
De-Aging
Can’t Get You Out of My Mind

Tags: comics medicine transfusion exchange transfusion captain america zombies umbrella academy

A nice PSA parody from Scott Kurtz and PvP featuring “The Chessmaster”, Brent Sienna’s character from the super-hero RPG “Ubermensch”. Click on the image for the full version of the PSA As much as I enjoy the day to day PvP strip, I’ve always felt that Kurtz’s best work are his longer-form stories. These were originally published in the Dork Storm edition of the PvP comic, and I believe they have been since reprinted in at least one trade paperback (PvP: The Dork Ages). The Christmas story is classic, and the super-hero story this PSA is taken from is equally clever, especially Skull as the most succesful super-villain ever. This PSA is from PvP #2 (May 2001, Dork Storm). Art and words by Scott Kurtz. More PSAs Tags: comics psa pvp scott kurtz

So in this scene, is Elmer portraying a doctor…or a veterinarian?

Birds of Prey #115 “Underneath the Skin”
Sean McKeever, writer
Nicola Scott, penciler

On the one hand, it’s nice to see a comic book character doing CPR properly.
But on the other hand, I have to ask — was it the right thing to do? Helena (the Huntress) is a drowning (or at least a near-drowning) victim. She is not breathing. We know this because Zinda keep yelling at her to breathe. So then why is Zinda performing chest compressions? She needs to be focusing on rescue breathing. Remember the ABCs - Airway then Breathing and then Circulation. Zinda’s done A (briefly), barely touched on B, then skipped straight to C (all the while yelling “Breathe!” — which really should give her a clue.)

That’s not to say that drowning and near-drowning victims don’t have heart problems — they do. Cardiac arrest is not uncommon in these situations. But there’s no point in worrying about the heartbeat if the patient isn’t breathing. ABC, not ACB (or CAB or any other anagram).

On a side note, why is Zinda unzipping Helena’s outfit? Did it shrink so much in the water that it wasn’t allowing her to breathe? What’s the point of exposing her neck and possibly upper chest in this situation?

Finally some statistics:
50% of all drownings occur in pools.
98% of all drownings occur in freshwater.
0.0005% of all drownings occur when sneaking into an enemy lair in what is clearly a trap (unless you’re a super-hero, then that number jumps to 67%).

Tags: comics medicine birds of prey cpr rescue brathing huntress zinda