Dr. House is always talking about bizarre, weird, rare, crazy medical conditions. But is his diagnosis accurate? Let’s react!
Don’t have time to read this post? Watch the video here instead!
[Clip from House shows Dr. House viewing a female patient’s read-out of her sleeping brain activity. He explains the results to the patient.]
These were your brainwaves at 2:45 a.m. [Pointing to a spike in activity] Here it comes… as an abrupt jump from slow-wave sleep. This indicates partial sleep arousal. Most common type is somnambulism — sleepwalking.
That would explain why I’m so tired when I wake up!
Yes, and also why you were pregnant… and the hickeys and the carpet burn.
I had sex in my sleep?!
Sexsomnia is a documented disorder. You said your ex lives downstairs?
I’ll kill him!
Disorders of arousal are a complex array of different sleep disorders that occur during slow-wave sleep (during the first third of the initial deep-sleep period). Typical behaviors are confusional arousal or “sleep drunkenness” — exhibited by confused type behavior. There’s sleep terrors, where a patient can sit straight up in bed and oftentimes screams, somnambulism (or sleepwalking), and sleep-related abnormal sex behavior (or sexsomnia or sleep sex).
I’m going to write you a prescription for a low-dose antidepressant. Let you sleep better. If you want to save yourself the $15 copay, you could have sex while you’re awake.
Sexsomnia isn’t that common. It’s reported in about one out of a hundred patients who present to a sleep clinic for these types of disorders. Patients also typically have other sleep conditions (like sleep apnea), and treating that comorbid condition and resolving sleep apnea often resolves the sexsomnia as well.
[Next clip begins. Dr. House and Dr. Foreman are having a heated discussion in front of a female patient.]
That’s what made this thing rear its ugly head.
What thing? B12 deficiency? Are you having déjà vu?! We’ve had this conversation! She was given B12. She didn’t get better!
Yes, because someone else ate it. Get an abdominal MRI.
Patient [alarmed and confused]:
What are you doing? Don’t touch me!
See, there she goes. Paranoid delusions…
The most commonly ascribed symptoms for B12 deficiency are anemia, fatigue, headaches… There could be many different medical conditions which can also cause those symptoms, but it’s certainly an easy thing to check — and an easy thing to resolve by taking B12 supplementation. In rare cases, there can be systemic side effects, central nervous system side effects, confusion, numbness, muscle weakness, indigestion, diarrhea…
Apparently, they have the diagnosis, they’ve done lab tests, and they’ve found that she’s vitamin B-deficient. And apparently, they’ve supplemented vitamin B12, but she’s not getting better. House said that somebody ate it — but I don’t know why somebody would take your vitamin B12.
[House pushes the B12 patient into an already occupied operating room and quickly puts on scrubs.]
Dr. House [regarding the patient already in the OR]:
Her hernia can wait!
They’re trying to kill me!
Dr. House [to the OR staff, annoyed and with a deadpan tone]:
Okay. You can either believe that we really are trying to kill her…
Doctor Rich [laughing]:
Okay, so in NO universe do you have a surgery that’s currently underway and it’s permissible to roll another patient into the OR that’s already occupied! The entire surgery room has been sterilized, and bringing another patient contaminates the whole sterile setup that you have in that room! And you can’t sterilize the room again for the patient that you’re about to operate on — so you’ve just basically ruined their surgery AND your surgery. So this is not a really plausible scenario here.
I’m going to need iodine, scalpel numbers 10 and 15, forceps, and a large salad bowl.
Alright. He didn’t scrub in. He hasn’t prepped the patient. So this is not going too accurately from a surgical standpoint here.
Okay, hold her down. [To the nurses] Come on, weenies! She’s in a cast!
[A nurse cleans the patient’s stomach with an iodine swab.]
Okay, well they did prep, at least…
[Dr. House asks for a scalpel.]
You’re not going to anesthetize her?!
Relax, it’s just a magic trick.
[House cuts into the patient, and she starts screaming.]
[To the nurses]
She’s faking. We’re not falling for it this time…
Yeah, I’m lost here…
[The woman stops screaming. Dr. House begins pulling a long parasite out of her abdomen.]
Ah, okay. It’s a tapeworm! That’s really disgusting.
Lake fishing can be fun. Giving room and board to this fella and giving all the free vitamin B12 he can take in.
So THAT’s where the B12 was going…
But I’m not sure why you don’t have to anesthetize a patient before cutting into their stomach to remove a tapeworm — and he wasn’t wearing a mask the whole time either!
So you typically acquire a tapeworm from eating undercooked meat or fish. Most cases are asymptomatic, so the diagnosis patients get is epigastric pain. They can actually have the sensation of movement around their bum. They can have indigestion. Sometimes the worms can affect their appendix, gallbladder, pancreas, and they can get diseases in those organs. Otherwise, they can have weight loss and in this case, vitamin B12 deficiency.
The diagnosis is made by a stool culture, and the treatment is a drug called PraziquantelⓇ or surgical resection as they gloriously demonstrated in this video.
Just next time, House — go ahead and schedule an OR! This isn’t an emergency — you can get in there, put the patient to sleep, and we can take the tapeworm out under more controlled circumstances.
So I’m going to leave House with a six out of ten. The disease conditions (the sexsomnia and tapeworm) are pretty cleverly crafted. The management of the tapeworm, that left a little bit to be desired as we discussed.
Extracting a tapeworm? Really difficult! Hitting that subscribe button? Very easy! I’d take the latter! We’ll see you guys next time.