House: Finding A Diagnosis

It's tough being the parent of a sick kid - especially if your kid's doctor is Gregory House.

House's team put two parents through the ringer for our viewing pleasure this week. Here's the diagnostic recap: "Your kid has pancreatitis. No wait...she has gallstones and needs surgery. No wait, she didn't really need the surgery, but she has this weird rash. It's allergies. No wait, it's Reye's Syndrome. Actually, it's flesh eating bacteria and we need to amputate her arm."

Finally, the real diagnosis, hard fought, was found: erythropoietic protoporphyria (EPP). The kid was basically so sensitive to visible light it causes a skin reaction.

EPP is a rare genetic disorder where an enzyme called ferrochelatase (FECH) is impaired and leads to the buildup of protoporphyrin in your body, causing your skin to be irritated by sunlight and even artificial light in some cases. The build up also causes problems with the liver and can cause gallstones, again, just like the little girl House didn't diagnosis, actually. Chase did. Score one for the sycophant.

The blistering and rash on the girl's body was characteristic of the disease and surgical lights can indeed cause that blistering, according to Louise Chang, MD -- one of our medical reviewers and a smart cookie. She said even sunlight streaming through a window can be a problem.

But folks with EPP can live fairly normal lives provided they take a few precautions, Dr. Chang said.

"The degree of light sensitivity varies. Activities and lifestyle need to be adjusted accordingly to avoid light exposure. This might mean picking a job indoors or night work, keeping skin safely covered to avoid exposure, window coverings. EPP isn't the only condition that causes sun sensitivity. There are support groups and a camp for children and families available year-round."

So what did House think the child had? Necrotizing fasciitis, or more widely known as "flesh eating" bacteria, for which there is no known cure. He was mighty quick to ask the child's parents if he could cut off the affected limbs. Why was he willing to be so rash? Dr. Chang said speed is of the essence.

"It is an aggressive infection, with about 30% of those infected dying from the disease. People at risk include those with weakened immune systems, other chronic or serious medical conditions, skin wounds - such as a cut or scrape, sores from a rash or chickenpox--taking certain medications or receiving treatments which may weaken the body's immune system.

Early treatment is crucial. This can consist of antibiotics and surgical removal of infected fluid and tissue. In severe cases limb amputation may be necessary to avoid death from overwhelming infection. These patients are very sick, so complications such as shock must be anticipated and treatment made accordingly."

Yep. Parenting ain't easy. Neither is being sick with House on call whether his diagnosis is right or wrong.


Related Links:

Sunburns and Other Sun Reactions,

MRSA Infections Can Be Flesh Eaters

Technorati Tags: House, HouseMD, flesheatingbacteria, photosensitivity, EPP, addiction

Nip/Tuck Amplifies the G-Spot

Oh, you naughty, naughty Nip/Tuck doctors. I thought I'd seen it all, yet you still manage to perform a provocative new procedure that left my cheeks flush with embarrassment and my belly aching with laughter.

In this week's episode, Dr. McNamara injected Restylane (a collagen-like product) into a woman's G-Spot to swell it in order to enhance her orgasms. He called it a G-Spot Amplification.

Believe it or not, this is an actual procedure performed by cosmetic surgeons. It's a fairly new procedure, and it was developed by hotshot cosmetic surgeon Dr. David Matlock. He's based in Los Angeles (of course), and he's appeared on the reality program Dr. 90210. According to his website, a G-Spot Amplification (or G-Shot) will "help women to become in tune to their G-Spot and by doing so elevate their sexual experiences to an ultimate level." The effects of the G-Spot Amplification last for 4 months, and the price ranges from $1,000 to $1,850 per injection.


Related Topics:

Sex Matters Blog -- Dr. Louanne Cole Weston

Cosmetic Surgery: A Better Sex Life?

Technorati Tags: Nip/Tuck, G-spot, G-spot Amplification

COTW: 3 Lbs. Presents Prosopagnosia 3 Lbs. Presents Prosopagnosia" title="Bookmark using any bookmark manager!" target="_blank">

Just when you think the number of doctors on television can't get any more crowded, along comes yet another show about super docs. 3 Lbs. is a new series showcasing neurosurgeons (interesting to see medical dramas now narrowing to a specific field); the title refers to the weight of the human brain. Is that weight accurate? Wikipedia says yes.

The show premiered a few weeks ago, and we must admit we haven't been watching. So many medical dramas, so little time. We tuned in for the first time last night, and the prognosis looks good.

Last night's episode of 3 Lbs. featured a patient who doesn't recognize people's faces. Interesting premise. But is it for real?

Yes. The condition is called prosopagnosia, and it's our Condition of the Week. Prosopagnosia, also known as face blindness, is a rare result of stroke or brain injury. The term is derived from Greek: prosopo means "face" and agnosia means "without knowledge." Harvard University is conducting research on prosopagnosia. According to their website, people who suffer from prosopagnosia "have difficulty recognizing people that they have encountered many times. In extreme cases, prosopagnosics have trouble recognizing even those people that they spend the most time with such as their spouses and their children." Most of the cases that have been documented are the result of brain damage following head trauma, stroke, and degenerative diseases. However, there are also cases of developmental prosopagnosia that are genetic so it could be inherited from a parent who is face-blind.

So what do people with face blindness see? Several websites run by face-blind people offer some clue what it's like living with the condition. Cecilia Burman compares the condition to picking out individual stones and provides several images of how she might recognize faces. Based on these picture, when she tries to remember someone, their facial features like the nose and mouth appear blurred or absent. Bill Choisser informs us that face-blind folks learn to recognize others by identifying alternative traits such as hair, clothing, body shape, mannerisms, emotion, and voices. It's because of this that face blindness often goes undetected.

How common is face blindness? A recent article in TIME magazine about prosopagnosia says it is "surprisingly common." It afflicts about 1 in 50 people. That's more than 5 million in the U.S. However, the degree varies widely.

What can be done for face-blind people? Validate their parking. That's what Dr. Hanson recommended on last night's episode of 3 Lbs. Though his attitude seemed gruff, he's absolutely right. Unfortunately, there's no treatment for prosopagnosia.

The docs on 3 Lbs. know their stuff.


Related Topics: New Approach to Stroke Recovery

Technorati Tags: 3 Lbs, brain surgery, face-blind, prosopagnosia

Grey's When is Helping Enabling?

This week Grey's hit on something that's often on my mind - aging.

Not so much for myself --yet --but for my parents who are in their late 70s. As we age all of us lose abilities to do this and that. Losing the capability to do certain things like driving means losing some of our independence.

But taking away the keys from a loved one who wants to stay behind the wheel is an extremely tough thing to deal with. You feel like you're taking away their independence -- and a piece of their life. And it's something that I honestly don't know how I'll deal with.

So far my parents are hanging in there. But that obviously wasn't true for the elderly man that drove his car into the fish market - seriously injuring many and killing at least one.

He had spinal stenosis, a condition caused by narrowing of the spinal canal. When severe, it can put pressure on the spinal cord and nerves coming off of the spinal cord. It's a common condition usually caused by degenerative spine disease from aging.

When it affects the nerves in the lower back it can lead to numbness, weakness, cramping, or pain in the legs. And as the docs in Grey's said, the elderly man shouldn't have been driving because he would not have good control over his legs.

So back to how do you steal a loved one's independence. I can't say that I have a great answer to that. What do you say? How do you tell them that it's time? How do you convince them the dangers are too great? If the situation comes my way I guess I'll figure it out then.

In the meantime this episode of Grey's made me realize I need to do whatever I can to get prepared for that time - for myself, for my parents, and for my family.

Related Links: Aging: It's Mind Over Matter, Caregiving Insights

Technorati Tags: greys, greysanatomy, drmcdreamy, caregiving, aging, spinalstenosis, spinalinjury

ER -- Scoop & Run

Just another busy Thanksgiving in the fictional County General ER.

Last week's episode - "Scoop & Run" - was centered around Dr. Abby Lockhart transporting an elderly patient from another hospital to County General.

Upon arrival at the other facility, they find that the patient, an 88-year-old woman, has had a heart attack. Her blood pressure is 74/38, even after they've administered Dopamine, and Abby tells the staff there that she doesn't understand why they are transporting this woman. She doesn't feel the woman will live through the helicopter ride and, even if she does, probably won't survive until her family is able to make it to the County General ER. But the male paramedic on the team pushes, telling the family this is their mother's only chance, and they transport her. The woman dies inflight.

I had to wonder if a patient who seemed to be on the verge of death would really have been transported at all...in the real world of medicine. So, I asked our expert, Dr. Michael Smith.

"Knowing when to transport a patient to another hospital can be tough in a critically ill patient. But transporting an 88-year-old heart attack patient with such low blood pressure (especially after receiving dopamine) is very risky. But it's a situation where you have to weigh the risks against the benefits of taking care of her heart. However, what bothers me most here is that it's the doctor's decision to transport a patient - not a paramedics (and I don't know too many paramedics that would put themselves out there like that and go against the physician that is going to be responsible for caring for the patient.) Looks like the doc knew best in this case."

Drama, drama, drama. It's entertaining, but it's not always completely accurate.

I certainly hope that if my elderly mom or dad is ever in that situation the hospital staff will be courteous and kind enough to allow my family to say a proper "goodbye".


Related Topics: Caution: Slippery Falls Ahead

Technorati Tags: ER, Thanksgiving, holiday, heart attack

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


Technorati Tags: HouseMD, House, chronicgranulomatousdisease, HepA, bonemarrowtransplant, stemcells

ER: Who Controls the Drugs?

Do doctors have open access to medications in hospitals or their offices?

In two recent episodes of ER and one episode of House, MD, physicians raided hospital "drug closets" for different reasons, seemingly without conferring with anyone else.

On ER a couple of weeks ago, Dr. Pratt learns from one of his elderly patients that the man's pastor has instituted a "drug exchange" program at his local church. Pratt visits the church and explains to Pastor Watkins that this type of exchange is very dangerous. It turns out that the man Pratt was treating was receiving a hypertension medication that he had been taking for years, even though his prescription had run out long ago. Pratt tells the pastor that this older drug isn't as effective in African Americans as some newer medications.

This past episode, we see Dr. Pratt volunteering at the church. But, when he writes an elderly woman a prescription, Pastor Watkins confronts him and says Pratt has to realize that these people just simply can't afford to pay...even their copays...providing they even have insurance. He tells Pratt to figure out how to pay for the medications himself or forget it.

Next, we see Pratt back in the ER. He is in the drug closet with a box and is taking things off the shelves. One of the new interns, Hope, comes in and asks what he's doing. He tells her he needs some things to help out the folks at the church, but he needs more. She points out that one of the drug reps was just in and may still be there. He runs out.

Near the end of the show, Pratt is walking back into the church with a box, accompanied by Hope. Watkins asks where he got all that stuff, and Pratt says, "I sold my soul to a drug company."

And, on a recent episode of House, MD, House puts together an experimental cocktail of L-Dopa to bring his patient out of a vegetative state for a short period of time.

We asked our own Dr. Michael Smith here at WebMD how realistic it would be for these docs to have this sort of access to hospital pharmacies or medication storage areas. Here is what he had to say:

"There's really no way for a doc to just walk into a drug closet and grab a bunch of drugs out of the ER or really anywhere in the hospital. They all now have those electronic tracking systems where you have to put in a code just to even get a piece of gauze out. Of course in a doc's office you could do that because no one really tracks it there, but I assume this happened in a hospital. Hospitals often do have pharmacies, which theoretically a doc may be able to sneak in there somehow. But again, if they were going to grab a bunch of drugs, that certainly would not go unnoticed."

Keep in mind that a lot of what may have gone on in the background may have not been written into the script. Perhaps Dr. House and Dr. Pratt DO have electronic cards that give them access to these areas. Or, maybe we are just to assume that they've gotten permission from the hospital "powers that be."

Food for thought.

Related Topics: Brand RX Prices Rise Another 6.3%, Medicare RX Benefits -- 2006

Technorati Tags: ER, House,MD, drug exchange

Grey's Anatomy: Mr.O'Malley's Esophageal Cancer

When George's dad was diagnosed with esophageal cancer my first thought was "What a great cancer to bring up because that's one of the few cancers that's actually increasing in frequency."

But Grey's writers didn't get it quite right.

Deaths from most common cancers have dropped in recent years. But that's not true for esophageal cancer, which continues to rise. The National Cancer Institute estimates that around 15,000 people will be diagnosed with esophageal cancer in 2006 with nearly 14,000 people dying of this aggressive cancer.

We don't exactly know why it's getting more common. But there's one risk for esophageal cancer that may be the culprit.

The type of esophageal cancer that's on the rise is seen more commonly in people with heartburn. And one of the big risks for heartburn is being overweight. You can probably see where I'm going with this.

While Grey's writers didn't work heartburn into Mr. O'Malley's medical history, his big belly - and the diet and lifestyle that likely goes along with that rotund abdomen - makes him the perfect candidate.

That big belly puts increased pressure on his stomach, causing stomach acid to bounce back up into his esophagus where it doesn't belong. Over time, this acid can cause abnormal cellular changes in the esophagus - called Barrett's esophagus - which can lead to cancer.

As we continue to see more overweight and obese people, we're likely to see more people with chronic heartburn - known by doctors as gastroesophageal reflux disease or GERD - and very possibly more people with esophageal cancer.

That's why it's so important to not just continue to pop over-the-counter heartburn medicines without seeing your doctor. If you're having heartburn two times or more a week, you really need to talk to your doctor about it. This could be a sign that you have GERD and at increased risk for esophageal cancer. Treatment can help prevent cancer.

Now to where the writers got it wrong.

They said Mr. O'Malley had stage 3 "metastatic" esophageal cancer. That's an incorrect description because he apparently has stage 4. They said it "metastasized," which by definition means it's stage 4, the most severe form of cancer. Most patients with esophageal cancer are diagnosed with stage 4 and that's a big reason why it's so deadly.

Overall, fewer than 5% of people with esophageal cancer live for more than 5 years. And with Mr. O'Malley's stage of esophageal cancer, death is imminent -- probably within a year.

You can see now why George was so upset he couldn't even tell his dad. He had to get Cristina to break the news.

There is no way to cure stage 4 esophageal cancer and treatment is focused on relieving any symptoms the patient may be having, such as trouble swallowing. Chemotherapy may still be used to help buy some time, but it won't cure the cancer.

We have no way to screen for esophageal cancer and that's why prevention is best. In addition to getting heartburn under control, other ways to help prevent esophageal cancer are not smoking and avoiding heavy drinking.

Related Links: More On GERD Complications , Esophageal Cancer Treatments By Stage

tags: greysanatomy, drmcdreamy, esophagealcancer, GERD, cancer

House's "Coma Guy": Pure Sci-Fi

There's so, so much I could say about last night's episode of House. I guess if you like a good fantasy story, the show was fine, but as a physician, watching "Son of Coma Guy" was just embarrassing. How much misinformation can be crammed into a one-hour segment?

Let's start with the central figure of the episode - the "coma guy." In describing this unfortunate individual, much is made of the difference between "coma" and "persistent vegetative state." According to the National Institute of Neurological Disorders and Stroke of the U.S. NIH, a coma is a profound or deep state of unconsciousness in which the affected individual is alive but is not able to react or respond to life around him/her.

A persistent vegetative state, in contrast, refers to a condition in which individuals have lost cognitive neurological function (thinking) and awareness of the environment, but retain noncognitive function (like breathing and circulation) and a preserved sleep-wake cycle. Persistent vegetative states may follow comas and last for years, while comas normally don't last much longer than a few weeks.

So in the episode, House brings someone out of a persistent vegetative state - albeit temporarily - with a cocktail of L-Dopa (a drug used to treat Parkinson's Disease) and amphetamines. Do I really need to explain that this has never been done, likely can never be done, and is entirely based in the fantasy of the writers? I can also point out that docs (even House, if he wants to keep his license, but that's another story, especially with his drug habit) don't just decide upon and administer experimental treatments on a whim?

Painful as this is, let's now suspend judgment and assume that Dr. House's magical cocktail can really work. In 10 years of a vegetative state, the body undergoes countless changes and degenerative processes, only one of which is significant muscular atrophy (wasting) that would make sitting upright difficult, let alone walking. So coming out of a coma, excuse me..."vegetative state," and hopping in a car to drive to Atlantic City is beyond absurd. As is House's knowledge of exactly (practically to the minute) how long his patient will be awake.

In summary, the show was science fiction, and nothing more. Perhaps it was intended this way, to create a new genre of medical fantasy. Still, UFOs and aliens are somehow more believable than this.

Related Topics: Best Place to Have a Coma: Soap Operas

Technorati Tags: House, coma, vegetative state, L-Dopa

ER Does Multiple Personality

What do you suspect when a patient you treated just a few hours ago returns to the ER and then claims to have no recollection of having been there before? On ER, Dr. Archie Morris was soon convinced his patient had Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder.

When Clyde Sandberg first enters the ER (during last week's episode, Jigsaw) he seems on edge, almost too tuned in to the sights and sounds around him. Suddenly, he drops to his knees in front of a little boy who is playing cars on the floor and starts talking to him and playing with the cars as well.

The boy's mother draws her son away from the stranger, and this seems to further agitate the man. He starts to freak out and bangs on the window separating the triage nurse from the waiting room, cursing and pointing out that there is a room full of people who need help out there. He says, "All I got's a little congestion. Think you morons can handle that?"

Nurse Sam comes to the rescue and gives him the forms he needs.

Next, we see him behind the curtain being examined by Dr. Morris. He continues to insist he has the flu, but tests show that there is a problem with his heart. It is twice the size it should be, and he has developed a pericardial effusion, which is why he's having trouble breathing. (X-rays also show that the man has many old, healed fractures. And, he is covered with cigarette burn scars.) He's going to need the fluid drained through a pericardial tap.

When he hears this news, Sandberg leaps from the bed and storms out of the ER, yelling, "Let me the hell outta here!"

Later on, two men are brought in by ambulance after having a violent altercation. Morris is surprised to find that not only is one of the men Sandberg, but that he claims he has no memory of being in the ER earlier that day. He says his name is Willis Peyton.

When told about his condition, he readily agrees to the pericardial tap. However, just as Morris is getting ready to do the procedure, a kid in the ajoining room begins to scream and flail around, triggering Clyde to come back. He begins cursing and refuses the treatment yet again.

Soon after, Morris approaches the ER's resident Rock Doc, Ray Barnett, and tells him he has found out that Peyton has been to the ER many times over the years due to childhood abuse. He believes Peyton has DID and wants Barnett to agree to join him in "double-doctoring" Peyton, but he refuses. (The term "double-doctoring" was not explained on the show. The only reference I could find to "double-doctoring" is that it refers to patients who visit different doctors in order to obtain prescriptions for controlled substances.)

Dr. Pratt also refuses to take part in "double-doctoring" (whatever that is), and suggests that Morris simply treat conservatively and wait on the psych consult.

In the meantime, Nurse Sam is talking to Sandberg/Peyton and offering him a little tough love. She explains that if he doesn't have the fluid drained from around his heart he could die. She says she knows he's scared and hurt, but he's in a safe place.

He looks at the light and his demeanor changes again. Peyton is back. He asks, tentatively, if he was sleeping. Sam says, "No." He sighs and says he has lost time again. She gently tells him about dealing with Clyde. Then, she explains again the urgent need for him to have the procedure but that they can't do it without Clyde's permission.

Sam provokes Clyde to come to the forefront. She tells him that Peyton isn't a coward like he is, which prompts him to give in.

After the procedure, Morris comes in to visit and it is obvious right away that the personality there on the bed is neither Peyton nor Clyde. In a small, fearful voice, he tells Morris his name is Andre and says, "Don't tell my dad I'm here. Okay?"

As the show ends, Andre says, "It's kinda dark in here. You're not going to leave are you?" Morris reveals a glimpse of the doctor he has the potential to be when he pushes his stool closer to the bed and kindly assures his patient, "I'm here all night."

Though Mulitple Personality Disorder has come a long way since the days of Sybil in the 1970s, some mental health professionals still seem to be skeptical.

WebMD's sister site, eMedicine.com, states:

DID is thought to begin in childhood in response to repeated traumatic and/or overwhelming life experiences, most of which involve physical and sexual abuse. Other traumatic events include long and painful childhood medical experiences and wartime dislocation. In studies of patients with DID, a range of 70% of patients to more than 95% of patients reported childhood abuse. However, some patients cause controversy because they revise their histories as treatment progresses.

POLL: Do you think DID is real? Why or why not?

Related Topics: Healing the Doctor-Patient Relationship>

Technorati Tags: Dissociative Identity Disorder, DID, ER, Multiple Personality

Grey's Anatomy: A Moral Dilemma

Last night's episode of Grey's Anatomy ("Where the Boys Are") left the female docs holding down the fort along with plastic surgeon Mark Sloan, who performed a procedure known as gender reassignment surgery (or sexual reassignment surgery) on transgender patient Daniel/Donna.

I was asked if gender reassignment surgery (sometimes inappropriately referred to as a "sex change operation," since it's impossible to change a person's genetic sex) is part of general surgical training, and the answer is no. Gender reassignment is only done by a few surgeons (often plastic and reconstructive surgeons) with experience and training in the procedure, and presumably Dr. Sloan is one of those.

While gender reassignment surgery isn't the surgeon's daily bread and butter, it also isn't that new or that rare. First developed in the 1950s and introduced in the U.S. in the mid-1960s, sexual reassignment surgery has been around a while. The goal of the surgery is to change the physical appearance and sexual functioning of one person to those of the opposite biological sex, and it has become an accepted treatment for the condition known as gender identity disorder. The surgical procedures for male-to-female reassignment are currently more refined and more commonly performed than those for female-to-male gender reassignment.

Here's where we must give the writers credit for introducing a medically credible and ethically challenging twist to the story: the preoperative workup reveals that transgender patient Donna has developed breast cancer. It's generally accepted that the longer a women is exposed to estrogen, the greater her risk of developing breast cancer.

Early onset of menstrual periods and late menopause can both increase a woman's risk of developing breast cancer, for example. Prior to male-to-female reassignment surgery, patients are generally required to live as females and take female hormones (estrogens) for at least a year. In these cases, taking estrogen produces and maintains female secondary sexual characteristics, such as breast growth and changes in growth and deposition of body fat.

The bad news is, as Meredith explained to Donna, that the hormones she is taking (and will be required to take following surgery for the rest of her life) are "feeding the cancer." Hence the ethical dilemma. Stop the hormones and treat the cancer, and Donna must become Daniel again. Proceed with the procedure and hormone therapy, and increase the risk death from cancer. Aware of the risks, Donna chooses the latter option.

I'm not aware of any reports in the medical literature about breast cancer in transgender women on hormone therapy, but the scenario in the episode is definitely possible and believable, albeit probably extremely rare. Breast cancer can and does occur in men, accounting for about 1% of total breast cancers, and elevated levels of estrogen (as can occur with cirrhosis of the liver or the genetic condition Klinefelter's Syndrome) is a known risk factor for male breast cancer.

So, again, applause for the writers of Grey's for constructing a medically and morally challenging, and even feasible, surgical case.

Related Links:Why Women Avoid Mammograms

tags: greys, greysanatomy, grey's, grey'sanatomy, drmcdreamy, drmcsteamy, breastcancer

The Nip/Tuck Pregnancy Plan

So how does an ex-pornstar turned Scientologist prepare for the birth of her first child? That's the dilemma facing Nip/Tuck's Kimber now that she's married to Matt and pregnant with his baby. Naturally, she needs the help of hotshot plastic surgeons McNamara/Troy.

First, she wants her breast implants removed so that she'll be able to breastfeed her baby. Since more women, particularly young women, are getting breast augmentation, breastfeeding is a growing concern for women with implants. However, implants do not automatically mean a woman won't be able to nurse her child, as Kimber seemed to imply. Many women with breast implants successfully breastfeed their babies, though certain methods of breast augmentation may decrease the chances of this success. According to WebMD's Guide to Plastic Surgery, if a woman intends to breastfeed, she should let her plastic surgeon know.

Next, Kimber treats her morning sickness with something called "touch assist," a massage-like procedure used by Scientologists to heal illnesses. I can't vouch for the medical validity of this procedure, but I can tell you how doctors recommend treating morning sickness. Taking ginger or vitamin B6 are two common means to effectively curb nausea and vomiting.

Finally, she'll discuss with her spiritual advisor the process of "silent birth," the birth method reportedly preferred by Scientologists. I'm not surprised silent birth is making its debut in a television drama, and I'm certainly not surprised it's appearing on an already wacky show like Nip/Tuck. Silent birth shot to fame earlier this year when Scientologists Tom Cruise and Katie Holmes announced that they would be having a silent birth. WebMD looked for medical evidence supporting silent birth, but we couldn't find any. "It may be in the Scientology literature, but it's not in the scientific literature," one doctor told us. On the other hand, doctors do agree that if a silent birth is something the parents want, their wishes should be respected, and there don't appear to be any serious risks. For more about the medical validity behind silent birth, go here.

Related Topics: What's Wrong With Silence and Birth?

Technorati Tags: Nip/Tuck, silent birth, morning sickness, breast implants, breastfeeding

House: Big, Fat Lung Cancer

In last night's episode, Que Cera Cera, House pinpoints George's (a 600-lb. homebound headhunter and gourmet cook) mystery ailments as late-stage, terminal lung cancer. How? By taking the diagnosis in hand, literally. House noticed the patient had finger clubbing.

Clubbing, or digital clubbing, is actually a medical term and can be a symptom of lung cancer, according to the Cleveland Clinic. "The nails appear to bulge out more than normal."

In fact, according to our sister site eMedicine.com, "Clubbing has been reported in 29% of patients with lung cancer, and is observed more commonly in patients with non-small cell lung carcinoma (35%) than in patients with small cell lung carcinoma (4%)." The site goes on to say clubbing is a tell-tale sign of "various underlying pulmonary, cardiovascular, neoplastic, infectious, hepatobiliary, mediastinal, endocrine, and gastrointestinal diseases. Finger clubbing also may occur, without evident underlying disease, as an idiopathic form or as a Mendelian dominant trait."

Now, clubbing usually can be readily identified in a sight exam. But for this particular patient, whose hands were swollen by obesity, the clubbing just looked a part of his weight issues. And about those weighty concerns...Dr. Chase felt that a morbidly obese patient like George didn't deserve the quality of care a normal weight patient would, because, obviously, he wasn't participating in his own health care. Why then should House and his team go out of their way?

The team did start with obesity as the first line of investigation of his problems, even though George said he'd been overweight all his life and it had never been a health issue. Is it a form of prejudice to start with being overweight as the cause of all your ailments?

I called Brenda, one of our Real Story writers, who two years ago was about 300 lbs. and underwent bariatric surgery, chronicling her dramatic weight loss in her online journal at WebMD. She TiVos House regularly.

"I believe that there are many people, not necessarily just those in the medical field, who agree with Chase, that obese people create their own situation so they should just live with it and not expect to be treated the same as a person who lives a healthy lifestyle," she says. "I believe that there is a similar attitude toward smokers. If they develop breathing problems or lung cancer, some people think they're getting what they asked for."

While no one asks for cancer or any disease, folks need to be responsible for their own health, Brenda says. "At the same time, every patient should have access to diagnosis and treatment."

Tell us what you think.

Related Topics: Surgery Options for the Obese

tags: House, HouseMD, lungcancer, fingerclubbing

ER Explores Malpractice: Who's Right & Who's Wrong?

Last week's ER was partly a continuation of the storyline that began two weeks ago as we saw Dr. Kovac being sued for malpractice by former ER patient Curtis Ames, played by actor Forest Whitaker.

In case you're just catching up, Ames presented in the fictional County General ER with a cough. He was there for a number of days, never got a room, and eventually ended up collapsing with a debilitating stroke. In the previous episode, we got to see flashbacks to what happened from three viewpoints: Ames, Dr. Kovac, and Nurse Chuny Marquez. Naturally, each of them remembered what happened differently, and it was interesting to see that unfold.

Last Thursday, the verdict was finally in, and I watched, torn in two, as Ames saw his dreams of justice go down the drain right in front of his two little kids. But, unlike Mr. Ames' character, who only has only the point of view of what happened to him that faithful few days in the ER, we viewers have gotten to know Dr. Kovac and nurse Chuny over the years. We know them to be flawed but kind folks. From our distant view, we know they probably did all they could with the resources they had at the time. And, I, the happy viewer, was glad to see Dr. Kovac win out.

Now, to me, this storyline gives us a poignant view of how wrong something can go during that trip to the ER.

We've all been there, you walk into your local ER and up to the desk. They ask you a slew of questions, eyeball you a bit, and then hand you a mountain of paperwork to keep you occupied during the vast number of hours you'll probably be sitting there. Unless, of course, you are brought screaming in on an ambulance and strapped to a gurney with a GSW (That's a gunshot wound for those of us who watch ER on a regular basis.)

In most emergency rooms you'll probably see the triage nurse sometime during the filling out of the paperwork. She (or he) will check all your vitals, like temperature and blood pressure, and determine how urgent your situation might be.

Then, when you are finally called back to be checked out by the rest of the medical staff, you may be lucky to see an actual physician for more than five minutes. Even though we know that it may not be necessary to take up any more of their time, it is still irritating. I've found it especially irritating when I have been in the ER with one of my kids, playing the part of the frightened and frazzled mother. It's hard to be rational when you or your loved one is bleeding or vomiting profusely.

If you have spent more than three hours in an emergency room during your lifetime, you can probably relate just a bit to how Curtis Ames must have felt as he waited and waited for someone to help him.

But, you can also see the point of view of the overworked ER staff who evaluated him and had to put him off in order to care for those they considered their more urgent patients.

This ER episode was wrapped up as Ames bursts into the ER to confront Kovac and accuse him of celebrating the verdict after it was read in court. He is dragged out by security crying, "I want my life back!"

Kovac follows and attempts to explain that he did all he could. Ames reveals that his pursuit of justice has cost him his marriage. Both men stand there, flawed, hurt, looking at each other. Kovacs tells Ames to contact him if he needs help with anything. Ames asks him to call him Curtis. They walk away. And, I was left with the feeling that neither of these guys was a winner.

Is our emergency medicine system as good as it could be? Maybe that depends on where you live. What do you think?

Related Topics: Things Your ER Staff Wants You to Know, What to Expect in the ER

Technorati Tags: ER, medical malpractice

Grey's Tale of Two Uteruses

Two uteruses? I'm sure there are many women out there thinking one is plenty.

But this rare condition is exactly what one woman was dealing with on last night's Grey's Anatomy.

Of course her story was particularly spicy. Not only did she have two uteruses, she was pregnant with two babies. And I'm not talking your average set of twins. These babies were 6 weeks apart in age. And yes, that can happen too.

The exact name for this condition depends on what the woman has two of. Some women have double everything - uterus, cervix, and vagina. This is called uterus didelphys. Other women have two uteruses and cervix but only one vagina. This is called uterus duplex bicollis.

But the writers didn't stop there. The two babies actually had different fathers. And I have to admit that I had no idea that could really happen.

Just last year a woman in Romania had two uteruses and gave birth to twins two months apart. As far as I know they were from the same man. As far as I could tell, this is the only reported such case.

It is unusual for a woman to be able to get pregnant again once she's already pregnant. Usually a woman's hormones during pregnancy prevent her from ovulating and being able to get pregnant again.

However, it apparently can happen. I have to give kudos to Grey's writers for presenting such an extraordinary medical case that is actually based in reality. A woman pregnant with twins 6 weeks apart wasn't the only thing I had never heard of.

In other surgical plotlines ... Cristina scrubbed in on a surgery called the "humpty dumpty" procedure. I'd love to know where Grey's writers came up with that name.

The surgery is real and can be done to remove a heart tumor as in the man in last night's episode. It's called cardiac autotransplantation as mentioned by his informed wife. He likely had a cardiac myoxma, the most common type of heart tumor.

But if anyone can figure out where the nursery rhyme reference came from, please share.

Related Links: Get Your Body Ready For Baby

tags: greysanatomy, greys anatomy, uterus didelphys, uterus duplex bicollis, mcdreamy

This Week's CC: ER Examines Broken Heart Syndrome

On last night's ER, Neela has to give a woman the news that her husband has just died in the operating room.

Upon receiving this news, the poor woman collapses to the floor and appears to be having a major myocardial infarction... a heart attack.

As panic ensues, Neela climbs onto the woman's chest and continues to perform CPR, insisting that the woman is experiencing Broken Heart Syndrome and it is reversible. After 20 minutes, everyone is urging her to stop compressions.

And then the woman's heart begins to beat again.

It's one of those magical TV moments that leaves you thinking... what the??? Can this REALLY happen?

Yep. Broken Heart Syndrome is a real phenomenon and this week's Crazy Condition. WebMD reported on Broken Heart Syndrome last year:

Researchers say the potentially lethal effects of emotional stress are well known in folk wisdom, as demonstrated by the phrases "scared to death" and "broken heart." But new evidence shows that broken heart syndrome may be an actual medical condition brought on by a surge of stress-related hormones that temporarily "stun" the heart.

All of the participants [in the study] had evidence of what was an apparent heart attack after sudden emotional stress, including news of a death, shock from a surprise party, fear of public speaking, armed robbery, a court appearance, or a car accident.

But unlike in heart attack patients, researchers found these people had no evidence of blockages in the arteries supplying blood to the heart. Blood tests also didn't show elevated levels of muscle proteins typically released after a heart attack from damaged heart muscle.

Related Topics: 'Broken Heart Syndrome' Mimics Heart Attack, Many Emotions Can Damage the Heart

Technorati Tags: heart attack, broken heart syndrome

Kidney Thieves Steal Nip/Tuck's Credibility

Ryan Murphy, the creator and head writer of Nip/Tuck, is oft quoted for claiming: "Our medical cases are 100-percent based on fact." The beloved episode "Momma Boone," about a morbidly obese woman who's become fused to her couch, is apparently based on the real story of a 480-pound Florida woman who died after emergency workers tried to separate her from the couch on which she'd been living for six years. Mrs. Grubman's plastic surgery addiction is an actual symptom of body dysmorphic disorder. And Hannah Tedesco's face transplant? The French did it.

No matter how ridiculous these medical stories seemed, they always hovered in the realm of possibility. So it's a wonder why the writers of Nip/Tuck are mining Internet urban legends for this season's stupid storyline about kidney thieves.

You know how the legend goes: A business man meets a beautiful woman in a bar while traveling. She suggests they go back to her hotel room, she drugs him, and the next morning he wakes up with a nasty hangover and an incision in his side. They've stolen his kidney. On the show, the kidney thieves are part of a highly sophisticated and well-funded crime ring commanded by Jacqueline Bisset.

Is there any truth to this storyline? Nope, nada. Snopes says this urban legend is false. It's a myth perpetuated by heavily forwarded emails warning travelers to beware.

We also wanted to get a medical perspective, so we checked with the National Kidney Foundation. From their website:

The foundation has received calls from concerned business travelers who have been warned by their travel agents to beware of the 'crime ring' when traveling. "It's an urban myth run amok," says Fred Herbert, chairman of the National Kidney Foundation. "There is no evidence that such activity has ever occurred in the United States," says Mr. Herbert.

It's a shame such a provocative show as Nip/Tuck has now turned to urban legends. Fans who stuck through the Carver storyline and Christian's sexual abuse are finally starting to see Fonzie strap on his skis.

UPDATE: We contacted the National Kidney Foundation to get the latest word on kidney thieves. It remains an urban legend. Jennifer Martin, Donor Service Program Director, told us there's "no case of anything like that actually happening." In fact, it's not even feasible. Jennifer said a potential donor has to undergo "a whole series of tests to determine if someone is a match. A blood test is the first one." On Nip/Tuck, the kidney thieves appear to be picking victims at random.

Jennifer said they understand that a television program is for entertainment. However, she said, "Even though people know it is a fictional show, they still believe certain elements of the show. It leads people to distrust the [donor] system. We hear from people who still believe things like this."

House: Fools for Angioedema

For the record, when I watch House, I feel like a rat in a maze.

I'm winding down paths, sniffing for that elusive diagnosis, hitting dead-end walls of wrong assumptions, my nose twitching, my brain fretting, my ears tweaking, driving to find the glorious cheese...er...condition, by luck and skill. Then a commercial comes on, and I remember a) this is TiVo and I don't have to watch the commercials and b) like any good maze, the mazekeeper has a turn coming I don't see.

So was the diagnosis for last night's episode, Fools for Love -- Hereditary Angioedema. (It's a nice couple of words to chew on. Take a minute.)

Basically a couple who grew up next door to each other, fell in love, got married, ended up the victims of an armed robbery, had what appeared to be an allergic reaction to the incident, and ended up with House and crew.

Later, after a million useful yet inconclusive tests, adding some incidental information that put a new turn in the maze, the couple found out they were half-brother and sister, and they both shared a disease that prevented them from making a protein their bodies needed to function.

According to our sister site, eMedicine, HAE is a rare disorder, occurring in in approximately 1 in 50,000 persons. It affects all ethnic groups, and, as the name implies, is hereditary. Translation: Unless you know a family member who has this, there's no need to stress.

But I think the bigger, more interesting discussion was the two doctors debating whether to tell the couple of their new predicament. In the end, I feel the right decision was made and no doctor can tell how folks will take the news they must tell them.

Related Topics: Things Your ER Staff Wants You To Know