House: Whac-A-Bone

You know you're being set up for a wild ride when you're watching a waiter and a giant rodent dance at a birthday party only to have the waiter vomit on the birthday cake.

From gastro-explosions to the rare Chronic Granulomatous Disease and a treatment that could cause some doctors pause before they recommend it. Yes, it's another edition of House.

First, let's review poor Jack (the dancing waiter and House patient du jour) and his cornucopia of disease. He had Hepatitis A, syphilis, eikenella, botulism, and aspergillis. Yep, this guy has more diseases than you can shake a Vicodin-addict's walking cane at. And then, during the course of the diagnostic process (otherwise known as plot development), House exposed Jack to serratia, meningococcis, cepacia, and rhinovirus. Exposed?? Read the recap.

Finally, Jack was diagnosed with Chronic Granulomatous Disease. A rare, inherited disease that affects your immune system. It prevents you from being able to fight off bacterial and fungal infections. It can be deadly, if left untreated.

Once they reached a diagnosis and began treatments for the existing infections, they pursued a match for a bone marrow transplant. They immediately did tissue sampling in his two siblings and found a match in Jack's 8-year-old brother.

Okay, back to bone-marrow donation. Why? Our Medical Editor Dr. Smith explains.

"That's not the first treatment we would turn to. But it's likely that Jack has been dealing with recurrent, serous infections for many years and would have already tried the typical approaches of preventative antibiotics and a medication called interferon-gamma, which helps stimulate the immune system. And bone marrow transplant (also known as stem cell transplant) is actually the only way to potentially cure CGD.

Stem cells are the most premature cells that can then develop into different types of immune cells and come from the bone marrow. The bone marrow essentially houses immune cells until they are released into the body to do their job."

But wouldn't Dr. Smith turn to bone marrow transplant? He says this course of therapy is a bit controversial.

"There have actually been very few stem cell transplants performed for CGD to date (only 25 or so that have been reported). Because of this it's really unclear how successful it is. But there are several reports of successful treatment. And even under the best circumstances the risk of death from the procedure is significant enough that many physicians are reluctant to recommend it."

Reluctance is never a characteristic I would use to describe House. But it does warrant the question: Do you always accept what your doc recommends as the next course of treament? Or do you question him as to why he is suggesting it?

Tell us what you think.


Related Links: Stem Cell Overview


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