HOUSE: Misleading Lab Results

Well, the television writers are back at their word processors, the actors are back on set, and so now I've got to get back to work and share my impressions about this latest episode of House titled "No More Mr. Nice Guy."

Just as a quick aside, I couldn't help notice that the opening scene involved striking nurses with picket signs hauntingly similar to the Writers' Guild of America placards - coincidence?

This week's puzzle involves an overly friendly guy named Jeff. He works around lots of cleaners and solvents. House discovers him in the Emergency Room. He has been sitting patiently for hours for a fainting evaluation. Jeff also has a history of dysgeusia (impaired taste) wherein everything he eats taste likes lemon meringue pie.

House is convinced that Jeff's peaceful, noncomplaining demeanor indicates occult pathology. In short, healthy people are not so placid. Since House is a lumper (tends to attribute most of a patient's symptoms to one central disorder) Jeff's demeanor and unusual taste phenomenon share a common cause.

Untreated syphilis becomes a central diagnostic consideration. If the bacterium involves the brain (neurosyphilis) there can be changes to mood, mentation, and motor skills. Blood is drawn and Jeff's serology tests are positive for syphilis. Shortly thereafter a tube of House's blood is inexplicably tested and it, too, is positive for syphilis.

We can skip the moral outrage concerning unauthorized testing of co-workers. Hey! This team performs routine home invasions of its patients to search for clues. "Mrs. Kettle, have you met Mrs. Pot?"

It's good to see that the writers have not lost their stride, pacing Jeff's various ICU crashes to precede each jumbo commercial block. Eventually it is discovered that House's sample was not his blood (meaning someone is still roaming Princeton with undiagnosed syphilis!) Jeff becomes hostile and mean-spirited while his overall medical condition continues to deteriorate. Repeat brain imaging reveals new lesions suggestive for a different kind of infection, a bug that could generate positive syphilis serology. We call this finding a false positive (tests confirms presence of syphilis where there is none).

Lots of medical conditions can generate a false positive syphilis test. Alternate testing like PCR (gene amplification) and selective immunoassays can help clinicians get to the truth. In Jeff's situation, he had contracted Chagas' Disease (a bloodborne protozoan that favors the heart and brain) while living in Central America many years earlier. It remained undetected for over a decade and insidiously caused his mood and taste abnormalities. Antiparasite medical therapy will eliminate the infection and hopefully normalize his central nervous system.

Here's a helpful take-away point: Whenever a physician informs you of unexpected lab results don't hesitate to ask if a second round of confirmative tests or alternative studies would be beneficial. It is never wise to base important health care decisions on a single tube of blood, especially when it might not even be your blood!

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• Understanding Lab Test Results
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The Biggest Loser - Couples: A Finale of Just Desserts

Well, it's over. We made it. And in the end, it was worth the weight! (You know we can never resist a good pun.)

In a season marked by overt sexism, blatant conspiracies and macho madness, the fact that "The Biggest Loser" was a woman, for the first time ever, was justice served. "1, 2, 3, PRIDE." Not so much.

The first few minutes of last night's finale was devoted to revealing whether Mark or Roger would be the third contestant in the running for the grand prize. Remember, "America Voted", and in another blow to Mark's fragile ego, Roger won the vote. Mark was relegated to the larger group of eliminated contestants, awaiting a lesser prize. Roger was a nicer person, and also a greater threat to win the prize. Mark didn't cry; we were very grateful.

We watched in amazement at the parade of contestants, their pounds having been shed both on screen and off, as they took to the scale for the final time. In addition to the grand prize of $250,000 and the the title of "The Biggest Loser", a secondary prize is awarded to a contestant who had been voted off but who achieves nonetheless the greatest percentage of weight loss among other ousted contestants. Again, justice was served, as Bernie won. Bernie, you may recall, was part of the duo of Bernie and Brittany, the two that did not know each other when the show began. And when it was crunch time, Bernie gave Brittany the opportunity to stay on campus rather than himself. He was sweet and supportive and clearly a fan favorite. And the taste of Bernie's victory was that much sweeter because he beat Mark, the ring leader of the macho blue team, by a single pound.

Bernie was one of Jillian's charges. Score one for Jillian.

Some of the contestants looked great; some less so, but all of them demonstrated some measure of change and we applaud them all for their efforts.

But in the end, Ali, once a champion synchronized swimmer, reclaimed her athletic soul, and pushed herself to achieve extraordinary results. She lost an amazing 112 pounds, 47.86% of her weight. She looked like the woman who was trapped inside the person who arrived nearly six months ago, and her transformation clearly took place on the inside as well as the outside. And Ali was also one of Jillian's people.

It was a victorious night on many levels. But the kudos go to Ali for her strength, character, and persistence. And oh yes, for kicking the butts of the macho men who worked all season to eliminate the women, one by one.

Go Ali. Go Jillian.

Wonder if those "Pride" tattoos can be removed?

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(c) NBC Universal.

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The Biggest Loser--Couples: The Weight is Almost Over

OK, last night was pretty good again. Still way too long, hence very dragged-out scenes with the remaining four contestants reliving their "journeys" from fat to fit. But seeing the transformations is really quite incredible and there is little to do but applaud their determination and their progress. All four: Ali, Kelly, Mark, and Roger have reason to be so proud.

And everything about this episode was designed to make them fully face their transformations and embrace their new selves. Even the final challenge of the season--putting on a fat suit that replicated exactly their original size and shape and running a foot race--made them all feel they were leaving behind the worst of themselves forever. They all vowed never again to be the people they were when they arrived. And they all discussed their transformation not only from a weight loss and fitness standpoint, but equally important from the point of view of the emotional weight they dropped as well.

Side Note: Speaking of emotions, Mark acknowledged what we all have been observing for some time now--that his emotions are a bit out of control. In Mark's case, his weight was blocking his emotions (and tear ducts!) and having unlocked that part of him, he has been some sort of human geyser, overflowing with tears and emotions each week. We also suspect that Mark has a little guilt over his brother Jay falling on the sword for him last week. Even Mark's wife, remember, told him to "Snap out of it." Mark should have an interesting homecoming.

Back to the show.

As with every episode, there is some sort of gratuitous product placement. The gum was replaced last night by Rocco DiSpirito, who is clearly being groomed as some sort of Biggest Loser chef in residence. He returned to transform each of the contestants' former favorite meal item into a healthier version of that very meal. Everything from pepper steak to ice cream. This was useful and fun information and it teed up the new "Biggest Loser Meal Plan". There is even a home delivery option. Second product placement plug.

Back to last night. Mark, of course, won the challenge, racing up that hill for the last time carrying a flag that read...well..."Mark." His prize was that when he gets home, he'll be provided with the "Biggest Loser Meal Plan" home delivery so all of his meals will be carefully created for maximum health and weight control. He also got $10,000. This gives Mark a decided advantage for the finale...except for one little problem: he was below the yellow line and therefore marked for elimination.

In fact, in what could only be characterized as the final irony of this season, Ali and Kelly were the two contestants to make it into the finale. Ali won the weigh-in again--that's four in a row--and Kelly was second. Both Roger and Mark, feeling fairly cocky as always about their "numbers" were shocked to realize that they were both below the dreaded yellow line. Truth is, all of the contestants put up great numbers, and they worked all week without their trainers.

But here's the twist: instead of Kelly and Ali determining Mark and Roger's fate...we will! America will vote, online, at The Biggest Loser, and that vote will determine whether Mark or Roger joins Kelly and Ali in the season finale. The results will be announced live in the first five minutes of the season finale next week. For all that Blue Team bravado, all those shouts of "1, 2, 3 PRIDE!", all that conspiratorial plotting against "the girls", look who's lobbying for votes now!

The show ended, as they do every season at this time, with each contestant saying goodbye to their trainers, alone in the weigh-in room, face to face with a cardboard cut-out of themselves as they looked when they arrived on campus. Standing side by side with their former selves, it's hard not to jump up off the couch and yell, "1, 2, 3, PRIDE!"

Remember to vote online and tune in next Tuesday to see if Ali or Kelly can become the first female Biggest Loser in the history of the show.

(c) NBC Universal.

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The Biggest Loser--Couples: Down Under

Without being overly optimistic about the future of this show, last night's episode was much more like what we remember fondly from seasons past--a focus on exercise and weight loss, genuine teamwork and interesting challenges. We think the contestants liked it better too--they seemed proud and engaged and determined. What a nice change!

The remaining five contestants spent a week in Australia with their trainers. Turns out Jillian and Bob are the trainers for the show in Australia so they were very familiar with the territory. Many of our fine now-slender friends had never left their home states, let alone traveled to the other side of the world. There was great excitement and anticipation and for once, it was not met with disappointment. They all had a great time. The stunning beauty of Sydney figured prominently in their experience and they learned very handy survival techniques for staying on a healthy course while traveling. Going to local farmer's markets to find fresh, healthy and inexpensive food to keep in their rooms; eating fish and vegetables when dining out; even dancing to burn a few extra calories. All of these options were presented in a very welcoming way and the show, as a result, was one of the most successful of the season.

The challenge was a modified triathlon, which all of the contestants completed. This made them feel like the champions they are, and we were impressed with their performances. But perhaps the most impressive moment last night came when Mark, who along with Ali is the most competitive and successful contestant, was just about to win the challenge. He has made it up that final flight of stairs, with only a few steps to go to reach the finish. In what can only be termed "uncharacteristic", he waited for Ali, who was very close behind, so they could cross the finish line together. In fact, Ali carried Mark piggy back over the line! It was miraculous--a real change of personality for Mark. And he talked about the difference in himself. The whole experience had more meaning for him because he finished with Ali. Is this the Mark who conspired to eliminate the "girls", one by one each week? The Mark whose only alliance was with the "guys" on Bob's blue team? You know, "1, 2, 3, PRIDE!"

Well, whatever caused this change in Mark, it was a welcome relief and it really did elevate the experience for Mark, for Ali, and for the audience as well. In sharing the glory, Mark also shared the prize--a sunrise seaplane ride, a brunch by the beach, and a call home.

Side note: Mark cried, of course, when he called his wife. You remember, he's the big crier. Maybe even The Biggest Crier. We were amused when his wife said, "Are you crying again? You've got to toughen up. Snap out of it!" We agree.

In the end, Jay, Mark's younger brother, and Mark both fell below the yellow line, each of them having gained a pound. In another embarrassingly tearful scene, Jay fell on the sword for his brother and went home, leaving four strong, competitive contestants to go on.

Next week the contestants will work without their trainers. Should actually be interesting. Two weeks in a row that are interesting? Fingers crossed.

(c) NBC Universal

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