TV Checkup

HOUSE: Kutner's Shocking Surprise

noreply@blogger.com (WebMD Blogs) — Tue, 07 Apr 2009 15:15:00 +0000

Dr. Kutner's suicide on last night's House left many of us shocked and surprised. And that's not so far from reality. It's always tough to imagine any loved one being miserable enough that they would actually take their own life. But the truth is that real-life suicide is often as unexpected as Kutner's.

If you have depression and are having thoughts of suicide, talk to someone. People care even though you may not feel they do. Don't have someone you feel comfortable talking to? Call a suicide hotline such as 800-SUICIDE (800-784-2433) or 800-273-TALK (800-273-8255) – or the deaf hotline at 800-799-4889.

Know someone who is depressed? First rule: never blow off even a brief mention of suicide in a loved one no matter how hard it is to imagine or deal with. Don't assume they're just trying to get attention. Talk to them. And explore. While it's a very tough thing to do, the best thing is to ask that person what he or she is planning. Let the person know you care and are listening.

Warning signs of suicide can be subtle, but oftentimes there are signs. And knowing what to say to a loved one is tough. See WebMD's "Recognizing the Warning Signs of Suicide" to learn more.

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HOUSE: Miscarriage of Honesty

noreply@blogger.com (Dr. Lloyd) — Wed, 10 Dec 2008 18:35:00 +0000

SPOILER ALERT!

Natalie is an unpopular, overweight teenager who concealed a full-term pregnancy, then discarded the products of her unattended delivery in a vacant crackhouse - or so she thought. Weeks later Natalie collapses, develops seizures, and spirals into multi-organ failure.

It was Cuddy, not House, who tumbled across the diagnosis: Natalie has eclampsia! (It is also called toxemia of pregnancy.)

Many of you know about eclampsia. This is a dangerous impairment of brain bloodflow usually associated with high blood pressure (most of the time but not always!) There are no effective preventive measures for eclampsia. If high blood pressure develops it can be treated and perhaps this eliminates many potential cases of eclampsis. Chronic headache and edema-related weight gain are important warning signs.

Eclampsia can be dangerous to both mother and fetus. Up to 5% of affected mothers succumb. Half the time eclampsia occurs prior to labor and another 20% encounter it in the delivery room. That leaves approximately 30% of eclampsia cases emerging postpartum (no harm to the neonate obviously!) Natalie's problems started one month after delivery, longer than the textbook timeline of 14 days. Who cares? When it comes to House I stopped arguing medical facts long ago!

The subject now switches to truth-telling. Episode 511 (Joy to the World) was loaded with lies, half-truths and deceptions. Nearly every character was dishonest at least once during the program: House, Cuddy, Wilson, Taub, Thirteen, Foreman, Natalie, her classmates, Kutner, and many more. For example, had Natalie confided in her doctors at the time of admission that she had recently delivered a baby, the diagnosis of eclampsia would have emerged far sooner - perhaps in time to spare her life. Of course, that is the most egregious example but Natalie and House's team were doomed by many other untruths that amused and entertained the audience.

Here's a bonus observation. Did you notice that House, the embodiment of ethical medical practice, never spoke to Natalie, not even once? That's how I knew she was a goner. I'll look for that behavior in future episodes and see if a trend develops. It's just as well he kept silent. He probably would have lied to her anyway, perhaps by wishing her a Merry Christmas.

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HOUSE: Compensatory Measures

noreply@blogger.com (Dr. Lloyd) — Fri, 05 Dec 2008 19:20:00 +0000

This week's episode of House (#510: Let Them Eat Cake) offered a powerful lesson in human behavior in depicting the lengths an individual will go in order to preserve one's health - consciously and unconsciously.

Emmy is a weight-conscious fitness maven who keeps collapsing. As a result of her workup (and multiple incorrect diagnoses) the team discovers that Emmy had undergone previous gastric bypass surgery. In the past Emmy was obese and she loved sweets. She still does!

Late in Act II House declares that Emmy suffers from Hereditary Coproporphyria. This is a metabolic condition caused by a defective gene involved in blood protein synthesis. These patients can experience severe abdominal pain and such attacks can be reversed with a bolus (large dose) of glucose. Earlier in life Emmy managed her disease by overeating carbohydrate-rich foods.

Believe me, it's not worth nitpicking the rest of this episode. We already have enough with which to work!

Emmy discovered that sweets eliminated her pain. No medical degree was necessary. Intuitive patients learn on their own how to compensate for their symptoms:

Young toddlers with cyanotic heart disease discover that they breathe easier when they squat

Folks with acid reflux often swallow a spoonful of sugar after eating tomatoes

Individuals with lactose intolerance shun dairy products

Gentle rubbing of the eyes can lower the intraocular pressure during a glaucoma attack

The point to remember is whenever you observe someone exhibiting unusual habits, you have to ask yourself, "Are they trying to compensate for some kind of unsolved problem?"

Here's another great example. There may be 23 million diabetics in America but at least 8 million of them don't know it! All they know is that they are frequently thirsty, love to drink orange juice (quick source of glucose) and tend to urinate more often than others. From a medical perspective the classic symptoms of diabetes include: polydipsia (excess thirst), polyphagia (excess appetite) and polyuria (excess urination). Sure, it all makes sense, but the diabetic patient is unaware of these facts: they drink, they eat, they pee!

Emmy's situation was very similar. She compensated for her symptoms and bought herself some time. Then, when she weighted 300 pounds she again compensated by consenting to undergo gastric bypass surgery.

Okay, I lied! Here's one diagnostic nit to pick. Remember when House requested a stool sample from Emmy? Had House been thinking of Hereditary Coproporphyria at that point in the story the laboratory could've tested the feces for stool coproporphyrins. In affected individuals stool coproporphyrin levels are markedly elevated, usually 10-200 times greater than control samples.

House decided that the best treatment for Emmy was surgical reversal of her gastric bypass and plenty of carbohydrates. He also could have offered the patient some hematin. The key treatment of porphyria is stopping heme synthesis. Hematin provides negative feedback to the heme synthetic pathway and shuts down production of porphyrins and porphyrin precursors. I don't remember hearing anything about that treatment.

So, how do we compensate for the miserable way this case was managed?

No more House for Emmy and, come next September, no Emmy for House!

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HOUSE: Face the Facts

noreply@blogger.com (Dr. Lloyd) — Tue, 02 Dec 2008 22:07:00 +0000

One-hour fictional dramas and 30-minute sitcoms are the staple of broadcast television. Granted, every once in a while NBC airs a string of 45-minute 'supersized' programs to lure viewers into staying tuned to their lineup. Following that theory, the viewer is trapped at 8:45pm after a supersized 'The Office' with nowhere else to go! Ever hear of TiVo?

Sometimes TV programmers air a full-hour program without commercial interruption. That requires re-editing when it comes time to repeat an airing of the show (or eternal syndication) so that space is available for commercials.

Another network TV gambit was the 'cold open' at 58 minutes after the hour immediately following the previously concluding program - and I mean immediately! No commercial break, no previews, no promos. Bang! New show begins. The strategy here is that the new show launches so quickly that the paralyzed viewer cannot react quickly enough to escape. Meet my little friend, the remote control!

Fox Television tried something a little different with Episode 509 of 'House' (Last Resort). They programmed the show to run 68 minutes in its entirety. Again, they create an automatic carryover audience but, nevertheless, they will need to trim the story when it comes time for recycling.

I can easily help House's editors chop 8 minutes from this week's extended episode. It all has to do with neurologic problems that affect the eyes, the eyelids, and the face.

A desparate gentleman named Jason takes hospital personnel from Princeton-Plainsboro hostage in order to recruit Dr. House's services. During the assessment House and Thirteen observe a subtle droop to the left corner of Jason's mouth. They suspect Bell's Palsy. This is the eponym for weakness of the seventh cranial nerve, the Facial Nerve. The Facial Nerve is responsible for chewing and facial expression: closing eyelids, raising eyebrows, lip and facial movement. It has nothing to do with facial sensation...that's the job of the fifth cranial nerve, the Trigeminal Nerve.

So, what caused the Facial Nerve weakness? House suggests postherpetic neuralgia (PHN). This is a chronic pain condition following a bout of shingles (Herpes varicella zoster infection). Next, House wants to test his hypothesis by injecting capsasin. I got lost here because capsasin is usually prescribed as a topical pain reliever - you rub it on. It is used to treat PHN by temporarily overriding the pain signals from the PHN-irritated sensory nerves. With capsasin PHN sufferers feel heat instead of pain. Then, to top it all off, when Jason reacts to the pain of the capsasin injection House hastily eliminates "Peripheral nerve paralysis" off his list of possibilities.

I may have missed something, but House appears to have criss-crossed his wires and his nerves. The facial droop and PHN consideration only involved cranial nerves that come directly from the brain. Cranial nerves are very different from peripheral nerves that connect to the spinal cord. (There is nothing 'peripheral' about either the Facial or Trigeminal Nerves). Next, since PHN affects sensory nerves, there is no 'paralysis' involved. Injured sensory nerves experience impaired sensation (too much is hyperesthesia, altered is paresthesia, too little is hypesthesia, none at all is anesthesia.)

Let's summarize. The lid droop reflected a possible problem with the Facial Nerve. House suspected PHN involving the Trigeminal Nerve. Whereas both of these problems involved cranial nerves, House performed a test of peripheral sensation and ruled-out paralysis. Yikes! Get the scissors out and we can get this extended episode back to 60-minutes in no time!

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HOUSE: Flawed Identity

noreply@blogger.com (Dr. Lloyd) — Wed, 19 Nov 2008 17:00:00 +0000

** SPOILER ALERT **

Sophia is a factory supervisor who collapses at work and ends up at Princeton-Plainsboro Medical Center. Hmmm...she looks kinda young. Sophia is actually 16 and living on her own - she is a legally emancipated teenager. With both parents deceased the courts recognized her as an adult, giving her personal responsibility and legal authority to make her own decisions. Sophia is found to have acute promyelocytic leukemia and needs a bone marrow transplant from a sibling or parent in order to have the best chance for survival.

There are just a few unresolved problems:

Sophia's parents are not dead
Sophia is responsible for her sole sibling's death
Sophia is not who she says she is, she is an identity thief

It seems 'Sophia' ran away from home out of guilt for her brother's accidental death. She fabricated (embezzled) a new identity and wanted to start over with a clean slate. (Funny...we never learn her real name?!?)

By now most of you are familiar with the serious identity theft problem that threatens every person in this country.

[A quick digression: I love watching the commercials with that CEO blurting out his social security number to boast about his anti-hacker software. How long before he gets burned?]

Anyway, do you know about Medical Identity Theft (MIT)? It is an enormous, underpublicized crisis that is compromising our entire health care system. MIT occurs when someone ineligible for health insurance uses another person's health card for doctor's visits, hospitalizations, prescription drugs, and other medical benefits.

Sophia may have been involved in MIT. Her factory job may not have provided comprehensive health care benefits. The 'real' Sophia's parents [still alive!] would probably need emergency hospitalization when they received the 'Explanation of Benefits' (EOB) from their health insurer - including a $250,000 bill for bone marrow transplantation. Fortunately, Sophia confessed by the end of the program and her real mother and father (still alive!) arrived at her bedside - hopefully with photo IDs.

According to the most recent government statistics approximately 3% of all identity theft cases involve MIT. That's over 250,000 victims per year and countless millions in illegal claims. With traditional identity theft stolen credit cards eventually get canceled and bogus charges are forgiven. Your credit rating remains bruised for awhile as you try to reconcile your accounts. When MIT happens the consequences are far more severe and far more enduring! Huge costs are quickly incurred and everybody ends up paying for the fraudulent claim (insurance premiums, local taxes, higher copays, etc.) Even worse, the victim's computerized medical records are permanently corrupted. Depending on circumstances, it would be very hard to acquire life insurance if your records say you have acute promyelocytic leukemia!

Just like a erroneous credit card charge, if you discover an incorrect billing statement regarding a family member you should fight it, fight it, and fight some more! If you know that the EOB is wrong alert your insurer to the possibility of Medical Identity Theft.

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HOUSE: Simulated Surgery, Real Deceit

noreply@blogger.com (Dr. Lloyd) — Wed, 12 Nov 2008 11:04:00 +0000

A young man named Nozick ("no sick"... get it?) suffers from agoraphobia (fear of public places) and collapses at home. He resists emergency responders who want to transport him to the hospital for evaluation. House's former fellow, Cameron, knows the patient and she recruits the team to help establish a diagnosis right inside Nozick's bedroom.

As usual, the guest star patient quickly decompensates and emergency surgery is needed. Anxious Nozick adamantly refuses to leave his bedroom. House announces a clever scheme: Let the patient consent to surgery that will be performed in his own house but, once asleep, transfer the anesthetized patient to Princeton-Plainsboro Medical Center for the exploratory procedure. Following surgery, drag Nozick back to his own bed before he wakes up.

You got a problem with that?

It is a different twist on sham surgery. Yeah, you read right - sham surgery. It's real medical terminology. Tell the patient you are going to perform a procedure on them, take them to the O.R., put them to sleep, apply a dressing and take them back to recovery.

Sham surgery and other sham treatments populate the medical literature. They demonstrate the power of placebo therapy to gauge treatment efficacy in randomized clinical research. For example, does removal of frayed knee cartilage improve long-term knee comfort? A study is designed where half of the patients receive knee arthroscopy with damaged cartilage removal while the other half merely receive peek-a-boo arthroscopy. The patients themselves are blinded as to which procedure(s) they received, and both have stitches and swelling after surgery. Six months later, surprise, both groups share similar statistics regarding comfort and function.

Just a thought; would phony 'gastric banding' lead to progressive weight loss simply because the patient believed their stomach was 50 percent smaller and thereafter were satisfied with smaller portions?

Faking surgery is more complex and more risky than swallowing a sugar pill.

Many medical ethicists claim that the routine use of invasive sham procedures is unethical and should only be reserved for special occasions where no alternative exists. They claim that research volunteers cannot render a valid consent because if they knew beforehand that they were going to receive the sham procedure they would never agree to undergo the procedure. The ethics of medical practice can also be applied to fictional medical dramas. As seen in House Episode 507 - 'Itch', there is no way Nozick would agree to undergo exploratory surgery if it meant leaving his home. That is where House's approach went astray and nobody intervened. Things went badly for the patient up until the end of the show when House opened Nozick's abdomen without anesthesia to remove some old bullet fragments.

Once again, I ask myself in horror, "Does anybody ever sign consent forms on House? Does it really matter?"

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HOUSE: Asleep at the Wheel

noreply@blogger.com (Dr. Lloyd) — Thu, 30 Oct 2008 13:54:00 +0000

Ready for a surprise? I actually enjoyed watching most of this week's House [Episode 506 "Joy"] because it taught me several things I had not previously known.

Jerry is a busy single father who experiences unusual neurologic attacks wherein extended periods of his day disappear as if they never happened. Time warp. Jerry and his single daughter live a spartan, isolated life: work and school. They do not socialize. In fact, they hardly relate to each other.

It doesn't take the team at Princeton-Plainsboro to establish that Jerry is a narcoleptic sleep walker. During attacks Jerry is a cocaine abuser, which only further aggravates his sleep disorder.

Chicken meets egg: Did the cocaine cause the narcolepsy that led to the sleepwalking (to buy more cocaine)? Much of the program tries to unravel that mystery until Jerry begins to perspire blood and goes into renal failure. House puts the pieces together and diagnoses Familial Mediterranean Fever (FMF). Jerry and his daughter are from the Middle East, a region where FMF cases congregate. The responsible genetic defect in FMF resides in chromosome 16 and it is passed along in an autosomal recessive inheritance pattern. Parents can be affected or carriers. Jerry is a widower and the cause of his wife's death was not mentioned. Jerry's only daughter apparently inherited the disease as well.

Now for the good part. House recognized that Jerry and his daughter exhibited anhedonia. Ever hear that word before? See the letters 'hedo' as in hedonism? These two bland, boring people found no joy is life whatsoever. Anhedonia is linked to various chemical imbalances in the brain as seen in depression, schizophrenia and drug addiction. Aha! The cocaine! Wait, don't take the bait! Jerry's daughter was not abusing cocaine. In their particular circumstance it was their Familial Mediterranean Fever that was responsible for their flattened mood.

House prescribed colchicine and melphalan to delay disease progression and inhibit additional complications that await FMF patients down the road. At the end of the program everyone was smiling - not really. Remember, this is House - not Full House!

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HOUSE: Time Is Running Out

noreply@blogger.com (Dr. Lloyd) — Wed, 22 Oct 2008 12:26:00 +0000

This week's episode opens with Thirteen enjoying a late night lesbian tryst complete with alcohol and ecstasy. Sounds pretty irresponsible for an on-call physician, especially one who is enrolled in a high-profile fellowship. The party ends abruptly when her partner Spencer (nice androgynous name) collapses. Thirteen brings the woman to the Princeton-Plainsboro emergency department for a complete workup.

Spencer experiences seizures, dehydration, chronic sleep deficiency, cardiac arrest, skin numbness. Each new symptom jump starts a fresh diagnosis and another invasive procedure - each of which triggers a more serious complication. Does the formula sound familiar? Meanwhile, Thirteen has to withstand the harsh judgment of her team members regarding her risky behaviors. It appears that both women are spiraling out of control.

House and others believe that Spencer has a fatal smooth muscle proliferation called Lymphangioleiomyomatosis (abbreviated LAM). Thirteen is told to notify Spencer of the bad news. Hmmm...a women dying from Huntington's Chorea counseling a former sex partner about certain death from LAM.

How strange! Spencer does not cry upon hearing such the tragic information. A-Ha! House deduces that Spencer does not have LAM (despite a confirmatory lung biopsy...darn those pesky plot details!) House bundles it all together as Sjögren's syndrome (SS), an autoimmune disorder characterized by loss of watery gland secretion (saliva, lacrimal, etc.) Activated lymphocytes attack the patient's own glands.

House based the diagnosis of Sjögren's on Spencer's failure to cry. Screenwriter whims notwithstanding, medical truth must prevail! I can think of three obvious flaws. For starters, Spencer appeared a bit young for Sjögren's. Next, SS most often accompanies mixed connective tissue inflammatory disorders like rheumatoid arthritis. Having reviewed Spencer's bedroom gymnastics (hello, TiVo!) I can attest that her joints were very flexible. Hospital closeup scenes of Spencer's hands revealed no joint swelling typical for rheumatoid arthritis. Finally, SS initially attacks the microscopic tear glands - leading to subnormal maintenance tear moisture content. The large lacrimal gland can still flood the eyes following a noxious exposure like tear gas or after psychomotor stimulation such as crying.

So, lo and behold, Spencer is not going to die anytime soon. At the same time, Thirteen's demise continues right on schedule. Is Thirteen crying for help or simply maintaining control over her choices? Is she trying to cram-in as much fun now as possible or has she embraced these self-destructive gestures so as to die before the Huntington's takes over?

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HOUSE: Pins and Needles

noreply@blogger.com (Dr. Lloyd) — Fri, 17 Oct 2008 15:01:00 +0000

It's a good thing Fox aired 'Birthmarks' after the Olympics. There were many offensive concepts in this week's fictional medical drama specifically relating to Chinese culture. Do you think Chinese parents insert needles into their infant children's skulls? Excuse me, I'm getting ahead of myself.

Magnetism was the central theme: House's attraction to Wilson, House's polarization from his father, and the adopted Nicole's transcontinental search to be drawn closer to her birth family back in China. Nicole is a drug abuser and smokes like a chimney. It appears much of her hospitalization is related to problems with different forms of iron.

At one point House's team suspects genetically-impaired iron metabolism - maybe hemachromatosis. (Medical geek point: House wanted to know if Nicole's birth parents had bronze skin as a sign of a systemic iron disorder. House was a bit rusty with the facts. The bronze skin discoloration from iron overload is not melanin; it is accumulated granules of hemosiderin and hematoidin - a breakdown product from iron-rich blood).

Later in the story it is revealed that Nicole's biologic parents inserted metallic pins into her soft infant skull in an effort to kill her in compliance with China's one-child per family population control policy. Nice... wouldn't a blanket have been sufficient? Apparently this parental shish-kabob approach to family planning backfired. Those intracranial pins turned into some kind of mega-acupuncture with the needle tips stimulating the pleasure/addiction centers of Nicole's developing brain. Small detail, but most acupuncturists that I know apply their needles (or a therapeutic staple) to the earlobe to promote smoking cessation.

Enough! By this time the entire plot was as difficult to consume as a mercury-laced, rat-stuffed dim sum washed down with a glass of contaminated Chinese milk. How did Nicole travel from America to China and get past the airport security metal detectors?!? "Excuse me, ma'am, but would you please remove your head?"

Still stuck on the magnetism theme, had Nicole undergone the planned MRI she would be in deep trouble. MRI, magnetic resonance imaging, relies on powerfully energized magnetic fields that would turn those pins into lethal projectiles. Magnetic items are never allowed into the MRI suite but surprises do happen. Some women experience 'tingling, burning hair' during an MRI scanning procedure. Guess what? Many hairsprays contain small quantities of elemental iron that cause this uncomfortable phenomenon.

By the end of the show the team tells Nicole that all of her problems will disappear once those nasty needles are removed. I don't think they nailed it. Postsurgical scarring in her traumatized brain tissue (reactive gliosis) may actually make things worse over time. Again and again I try to hammer-home the importance of never making overly optimistic promises to surgical patients. Give things time... at least until the next episode.

I'm done with this. My head hurts!

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HOUSE: Finding It Hard to Swallow?

noreply@blogger.com (Dr. Lloyd) — Thu, 02 Oct 2008 03:29:00 +0000

The guest star patient for this episode of House, M.D. (Adverse Events) had a bezoar. There! A top-line spoiler!

I suppose if you've never previously heard about a bezoar the climactic diagnostic surprise remains intact.

Portrait artist Brandon is struggling financially and participates in new drug clinical research to pay his bills. Unfortunately he was actively enrolled in three simultaneous medication trials: an anticoagulant, an immune modulator, and an antacid. Brandon's art suffers because of drug-related visual changes.

Despite hemodialysis Brandon has recurrent bouts of drug toxicity. Even a slow drug taper failed to control a serious heart arrhythmia. He also displays hypersexual aggression and his hair changes color. Problems progress as if the medicines were never discontinued.

In the end, all of Brandon's problems do trace back to adverse interactions between those three experimental medicines. The antacid slowed Brandon's intestinal motility and a clump of undigested matter collected in his gut. Supposedly, many swallowed pills got trapped in the 'hair ball' (yep, lay terminology for a bezoar!) So, even when Brandon stopped taking the pills his bezoar continued to leech drugs into his digestive system. Yecchhh!

The cast members took their turns disparaging clinical trials. In all fairness, the current system is among the world's safest and most rigorously enforced, but we need to do better identifying unscrupulous researchers, indifferent medical journal publishers and dishonest corporate decision-makers. There was no mention of Phases I-IV which prioritize drug safety long before efficacy is analyzed. Truth be told, most new drugs never make it out of Phase II (human safety).

While we are on the subject of truth-telling, much of the dramatic subplots in this episode focused on issues of honesty. Brandon nearly died because he failed to disclose his failure as an artist to his girlfriend and he covered that lie by choosing not to disclose his unauthorized entry into three different drug trials. Surgery yielded a football-sized bezoar and Brandon fully recovered - enabling him to begin formulating his apologies. He can start with the hospital cashier. Nobody explained how unemployed Brandon will pay the bill for his week-long hospitalization!

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HOUSE: What's Worse Than Rejection?

noreply@blogger.com (Dr. Lloyd) — Wed, 24 Sep 2008 19:50:00 +0000

I have received several comments recently that I should devote less space to plot synopsis and more text to specific medical issues that arise (erupt) during an episode of House,M.D.

It appears that I picked a great week to skip the plot synopsis because this week's episode ("Not Cancer") was already spinning out of control during the first segment.

Most viewers probably want to know: Can I acquire an organ donor's illnesses? The answer is a definite 'Yes'. If a donor has the corneal condition keratoconus (extreme irregular astigmatism) and the corneas are harvested for transplantation, the recipient will have keratoconus. It happens! Not only can transplant recipients develop the same illnesses that were present in the donor, the transplantation itself can generate some new ones. Let me explain.

Infected organs that are transplanted can quickly spread the infection elsewhere in the recipients body. Fortunately, today's rigorous organ screening procedures greatly limit this possibility. Typically, only healthy dead people (an oxymoron?) and healthy living people are acceptable donors.

A scriptwriting oversight deserves clarification. There are different types of transplantations: solid organ (heart, liver, etc.), tissue (tendons, corneas, skin), and bone marrow. They made a big deal that math professor Apple's cornea transplant was safer because the cornea has no blood vessels. That statement is meaningless. In the past cornea recipients contracted rabies from deceased donors. Somebody forgot to tell the morgue staff, "Don't harvest any donor tissue on this corpse!" Today that does not happen - end of story.

Solid organ transplantation requires extensive immunosuppression in the recipient to prevent the recipient's immune system from fighting the stranger's tissue, thereby causing organ rejection. You can see the problem here: profound immunosuppression makes the recipient highly vulnerable to opportunistic infections. Cytomegalovirus (CMV) is one such example. Most organ recipients with no prior CMV exposure take antiviral drugs after transplantation to prevent CMV infection.

Powerful immunosuppressive drugs can also cause problems. Individuals who contract Epstein-Barr virus infection (same bug that causes mononucleosis) while immunosuppressed may develop a lymphoma-type condition that is controlled, not by chemotherapy, but by reducing the level of immunosuppression.

Yep, organ transplantation is serious business. Besides hoping for a good tissue match and healthy acceptance of the new organ, transplant patients have to deal with the challenges of a compromised immune system, unexpected dangerous infections, and other complications that threaten the survival of both the transplanted organ as well as the life of its recipient. Having said that, organ transplantation means hope for a new life.

Hey, don't forget to become an organ donor - and notify your loved ones of your decision. Over half of all folks needing an organ transplantation die without getting it.

One final thought. Livers and kidneys aside, like an unwanted organ, Wilson continues to reject House!

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HOUSE: Season 5 Opener

noreply@blogger.com (Dr. Lloyd) — Wed, 17 Sep 2008 11:14:00 +0000

In front of her boss and a roomful of clients, Lou, an uptight legal assistant, develops hallucinations and senses ants crawling all over her body. She totally freaks and Season Five of Fox's House, M.D. is off to the races.

The season debut plot is complicated by unfinished business from Season Four. Dr. Wilson is still grieving over the death of his girlfriend (and former House fellow) Amber. Wilson announces that he is quitting Princeton-Plainsboro Hospital - a decision that completely perplexes House. So rattled is House that he ignores his new patient Lou in order to persuade Wilson to stay. His friendship with Wilson is more important than any challenging case.

The tables have turned in this episode. Whereas the 'social drama' typically represents the back story, this time the severely ill patient comes in a distant second. Oh, House also blurts out that Thirteen tested positive for Huntington's chorea, but that is one storyline that will need future episodes for deeper exploration.

The initial workup reveals anemia, bradycardia (slow heart rate), and hallucinations.

The team wants to cure a patient without relying on House.

In House's absence the team quickly burns through these diagnoses in order: Vitamin B12 deficiency, colon cancer, ordinary pregnancy, ectopic pregnancy, multiple sclerosis, extra-adrenal paraganglioma, amyloidosis, and secondary amyloidosis caused by lymphoma. Team members lie to Lou repeatedly. Very few confirmatory tests were performed. Without their mentor nearby to offer restraint and discipline these hotshots burp-up a suspected disease and treatment begins immediately: colonoscopy, laporotomy, therapeutic abortion, interferon, transrectal fiberoptic tumor manipulation (ouch!), even cancer chemotherapy. Somehow they still had plenty of time for the commercials!

The team realizes that they are pretty helpless without House. Sadly, he is no position to offer help. As a result the patient continues to suffer.

Meanwhile, House cannot accept the reality/responsibility that Amber died in the bus crash because she (instead of the unavailable Dr. Wilson) went to a bar to retrieve him. Dr. Cuddy tries her best to get House and Wilson to express their true feelings. It ends up that Wilson does not blame House, he simply is sick of enabling House. Wilson is tired of covering-up for his emotionally-troubled buddy.

Wilson says farewell. With nothing left to do, House returns to the ICU to see Lou. Inexplicably (as always happens in the final segment of this show) House order the chemo stopped because Lou does not have lymphoma! Get ready...Lou has lepromatous leprosy - that's the non-disfiguring kind. He takes a blood sample from a leg bruise for culture and orders antibiotics.

House was unclear how he arrived at the diagnosis, but after seeing how many other possibilities were already exhausted, House probably figured it had to be either lupus or lepromatous leprosy. And as taught in all previous episodes: "It's never lupus!"

I hope the soap opera ends quickly. As soon as Wilson's status is finalized it is possible that patient care will ascend in priority at Princeton-Plainsboro.

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Baby Borrowers - We Only Wish They Were Kidding!

noreply@blogger.com (Nancy Davis, Safety4Kids) — Mon, 07 Jul 2008 20:10:00 +0000

Last season we blogged Kid Nation and we thought then that reality TV had sunk about as low as it possibly could. We were wrong. Enter Baby Borrowers. This is one of those situations where if an extra-terrestrial landed on Earth and had the great misfortune of tuning in to NBC on Wednesdays at 9 PM, they would think, and rightly so, that they had discovered a cruel, masochistic life form. This is so bad that we won't be blogging about it - we can't bear to watch it - you have to draw the line somewhere!

The premise, for those of you clever enough to avoid such drivel, is that five teenage couples who have never before lived together, not only get a house in which to co-habit, but they get an infant to care for (and we use the term loosely). At least for a few days. We know what you're thinking - WHO IN THEIR RIGHT MIND GIVES OVER THEIR INFANT TO TEENAGE STRANGERS?!?!?!?!?!? Yes, well, this show requires that you suspend all intelligent impulses and questions, which is why we won't be blogging about it. We raised children. It's hard enough when YOU ARE the parents and YOU ARE adults and YOU DO live together.

Here's the good news: we can still be shocked and disgusted. We have not been so conditioned to reality television that we can accept anything thrown at us by the networks. Fortunately, we are not alone. Here's a paragraph from The New York Times:

The American Academy of Child & Adolescent Psychiatry said that NBC should end The Baby Borrowers, a reality television show that separates babies and toddlers from their parents and places them temporarily with teenage strangers. "A child's sense of security should not be gambled with," said Robert Hendren, the president of the academy. NBC has said that the Baby Borrowers is a social experiment that can educate teenagers on the responsibilities of parenting. The parents are able to monitor their children through video cameras.

One ad actually promotes this show as "birth control."

When did we as parents abdicate our responsibilities and leave it to reality television to teach our children right from wrong? Why would anyone let their teenagers learn life lessons from an entirely manipulated, revenue-driven load of crap like Baby Borrowers? Are parents that disinterested in their children? And if they are, perhaps they should have exercised birth control themselves.

(c) Photo Courtesy NBC Universal.

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Technorati Tags: Baby Borrowers, reality tv, parenting

HOUSE: Season Finale

noreply@blogger.com (Dr. Lloyd) — Tue, 20 May 2008 06:15:00 +0000

Spoiler Alert: Stay away if you haven't watched the complete two-episode finale! This post is loaded with spoilers!

The writers' strike-shortened fourth season of House has ended and labor unrest was only one unexpected twist to have affected the series. Since all three of House's previous fellows had left the team at the end of Season 3, House launched a 'Survivor' style elimination protocol to identify three new proteges from the unruly horde of applicants. That seemed so long ago. Much of the first 4 or 5 episodes were devoted to the competitors - House himself often seemed like a footnote.

Things progressed in predictable House fashion until Amber was eliminated. Amber, the cutthroat, throw-anybody-under-the-bus physician with absent scruples and conscience that rivaled Dr. House's worst behavior. How could they get rid of Amber? She's a perfect foil!

Surprise! By the time the strike was settled Amber was back at Princeton-Plainsboro still competing with House. This time, however, it was for the affections of oncologist sidekick Dr. James Wilson. Very clever; the writers kept her in the story but mostly as a sideshow attraction. In the climax of Episode 416, 'Wilson's Heart', Amber becomes the hub for the entire season.

It appears that besides Dr. House, Amber was also riding that ill-fated bus that crashed in the previous episode. She was escorting the drunken doctor back to his house in place of on-call Wilson. Amber sustains severe internal trauma, coma, arrhythmia and eventual irreversible multi-organ failure. They lower her body temperature to buy valuable time (at least 60 minutes, right?) Searching for answers, House continues to journey in-and-out of his foggy memories and foggier fantasies related to that tragic evening. Wilson becomes suspicious that House and Amber were secretly involved behind his back. Does he also suspect that House will let Amber die to hide the affair and to restore their buddy status? Nobody ever accuses anybody but you can definitely feel the tension.

If House can accurately reconstruct what happened to Amber he may be able to save her!

Deep brain stimulation is applied to further jostle House's fragmented memories. I may employ the technology next time I cannot locate my car keys! House collects the final clues which explain Amber's deterioration. Minutes before the bus crash Amber consumed the prescription drug amantadine to ward-off early flu symptoms. Her severe kidney injuries kept the drug from being metabolized so, in essence, she overdosed by taking just two pills. For the record, she only needed to take one. Once House shares his discovery, he suffers a seizure and lapses into coma. Darn that deep brain shish kabob!

House's team cannot save Amber by performing dialysis because the drug binds to albumin and will not be filtered-out. Maybe so, but wouldn't an exchange transfusion or emergent kidney transplant solve the problem? C'mon, find some spine! She was already receiving heart-lung bypass. At what point do you stop suspending disbelief?!?

Amber is aroused just long enough for her weepy boyfriend to say goodbye. Wilson then personally shuts-off the the bypass equipment (So long, dear, I'll miss you!). Everybody else reacts in their own way regarding the loss of a former colleague/competitor. House worries that Wilson will remain angry at him. Most of the cast succumb to their emotions - except for Kutner who enjoys a late night bowl of cereal and some TV. Hmmm...maybe he's watching a rerun of House.

Reruns are all that we get until Season 5 premieres in the fall. Pass the milk, please.

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HOUSE: Jarred Memories

noreply@blogger.com (Dr. Lloyd) — Tue, 13 May 2008 05:21:00 +0000

The fourth season of House concluded with a two-part finale. The first part (Episode 415, House's Head) has an amnesic Dr. House retracing his steps after realizing he had survived a bus crash four hours earlier. Many passengers sustained severe injuries. House is convinced that, moments before the crash, he recognized a person with diagnostic features for a life-threatening illness. But, which passenger and what illness?

House himself sustained a bone fracture involving the base of his skull with cerebral edema, yet he was able to mobilize his team and begin assembling clues. Most skull fracture survivors take to their bed and stay there. House underwent hypnosis in an effort to illuminate his misplaced memories and resolve his amnesia. Clever editing combined hypnotherapy and Vicodin-induced hallucinations. It was often hard to distinguish which events were recollections and which were fantasies.

A lot of time and energy was devoted to the bus driver. House theorized perhaps it was the bus driver who had an occult health condition that caused him to temporarily blackout. By the end of the episode House flushed the bus driver scenario - the passenger in greatest danger remained unidentified. Can you say 'cliffhanger'?

Now, don't worry about any spoilers because none are divulged in this blog post. Who knows what trivial plot details in this week's episode become the pillars of next week's closer?

What interested me most about this episode was the recognition that physicians often continue working despite illness or injury. Is it professional duty or fear of lost revenues? In my opinion it is a devotion to patient care that drives most physicians beyond their own sickness - even beyond the point of good judgment. I believe this is part of the reason why doctors make the worst patients. Watching the progressively disoriented House carry-on after sustaining serious head trauma, my wife quietly remarked, "...reminds me of February 1984".

Ouch, that hurt!

In February 1984 I was Ophthalmology Chief Resident: lots of patients, lots of surgery, lots of responsibility, not much money. For three days I kept working around the clock despite fever and abdominal pain. My wife repeatedly warned me that I needed to get help. I reassured her that I'd felt worse before. Denial reigns supreme! On the fourth day I collapsed from peritonitis due to my untreated ruptured appendix. Finally, I saw a doctor, had long-overdue surgery, and spent 10 days in a hospital bed hooked up to IV antibiotics. Had I gotten help sooner I never would have made myself so sick. Looking back at that experience I recall several hospitalized patients telling me, "Doc, you should be in this bed. You look worse than me!"

Professional journalists would howl that I have inserted myself into this story, which is supposed to be about House. What can I say? House's behavior is not unlike other doctors. You know, other doctors like me! It's great that I am not a professional journalist - just a medical blogger.

I dare not spill any beans regarding storyline specifics. Let's wait until Part 2 airs and we can wrap the entire season finale with one big ribbon (or head bandage!) TO BE CONTINUED...

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HOUSE: Judgment Day for Princeton-Plainsboro

noreply@blogger.com (Dr. Lloyd) — Tue, 06 May 2008 05:07:00 +0000

The portfolio of unpunished felonies continues to pile up for Doctor House. In addition to the routinely scheduled residential break-ins, Episode 414, 'Living the Dream,' opens with House perpetrating a kidnapping in order to confirm his suspicions that a popular soap opera actor has a brain tumor. The unsuspecting actor ends up in Princeton-Plainsboro and endures a lengthy series of invasive tests and near-death medical emergencies: cardiac arrest, kidney failure, extreme fever, coma, etc. Spoiler alert: dude had a rare allergy that was previously used in an ancient episode of Murder, She Wrote.

Do not despair. Even without Angela Lansbury this episode still had some entertaining drama.

For those in the medical community, the real plotline involved Dr. Cuddy's efforts to guide the hospital through its reaccreditation inspection. Every time House behaved at his worst the inspector was a witness.

Reaccreditation is a lengthy, expensive, time-consuming show-and-tell. The agency in charge (typically JCAHO - Joint Commission for Accreditation of Health Care Organizations) inspects every hospital with announced and unannounced visits. Ostensibly, the reaccreditation process is promoted to improve patient care delivery but, ironically, an upcoming inspection cycle often distracts many hospital employees from their real responsibility...helping patients. The reality is that most health care professionals see reaccreditation as a colossal waste of time.

Nurses and administrators maintain underground communications with their counterparts at other recently inspected hospitals to discover upcoming key areas of scrutiny. For example, one year such advance 'intelligence' warned that inspectors were particularly concerned about hospital staff knowledge regarding steps to take in the event of a fire. Sounds reasonable, right?

Many thousands of manhours were devoted to briefing (and rebriefing) employees, printing clip-on cheat cards, and mounting laminated signs on both sides of every door and approximately every 10 feet along both sides of the corridors. Good news! If you can just crawl 10 feet away from that blaze you will find laminated instructions that will help you escape...so long as they haven't melted! Every experienced clinician has 2 or 3 wild reaccreditation inspection stories to share. On inspection day nobody was asked anything about fires, but the outdated anesthetic ventilation system in the operating rooms took a big hit. Ooops!

Back to the show, the unyielding inspector learned about House's radical (read hair-trigger) approach to patient care: treat first, diagnose later. The soap-opera patient survived but it had no impact on the inspector's evaluation. Cuddy's hospital was cited and got socked with a fine but House got to keep his job and survive to violate his Hippocratic Oath one more time.

Hmmm, how often should prime time fictional medical dramas get reaccredited?

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HOUSE: Misleading Lab Results

noreply@blogger.com (Dr. Lloyd) — Tue, 29 Apr 2008 14:20:00 +0000

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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The Biggest Loser - Couples: A Finale of Just Desserts

noreply@blogger.com (Nancy Davis, Safety4Kids) — Wed, 16 Apr 2008 19:27:00 +0000

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

noreply@blogger.com (Nancy Davis, Safety4Kids) — Wed, 09 Apr 2008 11:12:00 +0000

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

noreply@blogger.com (Nancy Davis, Safety4Kids) — Wed, 02 Apr 2008 19:26:00 +0000

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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The Biggest Loser--Couples: This One Takes the Cake!

noreply@blogger.com (Nancy Davis, Safety4Kids) — Fri, 28 Mar 2008 14:08:00 +0000

There are only two shows left in the season and it's hard to know where the producers can go from here. They say, "When you hit bottom, there's no place to go but up." We certainly hope that's true, although there appears to be a special place reality television goes, and it's below bottom.

It was hard to watch the latest installment of Biggest Loser--Couples, and not wonder what aliens from a far off galaxy landing on earth might think. For argument's sake they land on "campus" only to find a man carrying around a slice of chocolate cake as a pet, while his compatriots tease him and hide his cake in the laundry to teach him to better protect his pet. And then these same people run up and down stairs, gathering junk food and placing it on tables, occasionally taking a bite. The point here was to put as many calories on someone else's table so they could lose the challenge.

The aliens would likely think they had landed on a planet where intelligence was not valued, but a high premium was placed on trans-fat. They would not be entirely wrong. But in watching the episode we felt more like the aliens.

A solid hour, we're not kidding, was spent on Dan's relationship with a slice of cake. He carried it with him everywhere. There were shots of the cake in the gym. Shots of the cake in the kitchen. It was downright bizarre. And idiotic.

And as if that were not idiotic enough, the second hour was centered around a challenge that was not only insulting and inane, but also infuriating. Infuriating because despite the fact that there are no real teams left, Bob's blue team remains strong and intact, and viciously determined to wipe out "the girls." They work out together, strategize together, and still raise their unified voice in "PRIDE" whenever they get the chance. And they approach each task with an eye toward how they can eliminate one of the remaining two women and strengthen their hold on the game. And because there are four of them and only two women, the women barely stand a chance.

The two remaining women, Kelly and Ali, have not exactly been united. Kelly is the sole remaining member of Jillian's black team, and Ali came back in that strange twist a few weeks ago, and still wears her pink team shirt with pride. This week, disgusted and demoralized by the men's behavior, the women decided to unite; Jillian gave them pep talk after pep talk and they rallied, determined not to be eliminated. In the end, the united men could not save Dan from elimination, after he lost only a pound. The women, in fact, were first and second at the weigh-in.

There were the teary goodbyes, now customary for the men. Weeping, vowing eternal love, pledging PRIDE despite the fall. Ugh. We're so sick of the men conniving and conspiring to gang up on the women, macho, mean, and ruthless, and then collapsing into quivering, sniveling babies at the end.

We have been saying for awhile now that this show has lost focus; this week proved once again that weight loss, exercise, healthy eating, changes in lifestyle--all take a backseat to pet cakes and boys versus girls sexist mentality.

Two episodes left. Four more hours. 240 minutes. But who's counting.

(c) NBC Universal.

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The Biggest Loser--Couples: From Fierce to Farce

noreply@blogger.com (Nancy Davis, Safety4Kids) — Wed, 12 Mar 2008 21:08:00 +0000

It's time NBC renamed this show "The Biggest Kvetcher". Seriously, if we have to continue to watch grown men and women crying over their interpersonal issues, we're going to start crying ourselves.

There is absolutely nothing of substance to talk about. Last night this show hit bottom. For no apparent reason, all of the previously eliminated players reappeared for a "special" weigh-in. The eliminated man and woman with the highest percentage of weight loss would come back on the show. This pissed off almost all of the remaining contestants, who thought they had long ago disposed of their fellow teammates and had reached the status of "final six".

Side note: the players who had been eliminated did not look very good. Other than the two who won, not much change to report.

Mark and Ali were reunited with the group. Mark, crying as always, over his brotherly love, easily assimilated back into Bob's team. One, two, three, PRIDE! It was another story entirely for Ali. She and her mom, Bette Sue, you will recall, had serious issues, but Ali was a fierce competitor and a friend to many of the men on the blue team. She chose to wear her original pink clothing, rather than adopt Jillian's signature black. Ali was keeping her options open. She was more interested in wearing pink as an homage to her mother than giving that up and joining the women in black.

And who could blame her?

Those women in black? Simpering, annoying, emotional wrecks. Crying, over-eating, barely moving on the treadmill...what's going on? Why isn't Jillian kicking their butts into high gear? And what about Jillian? She used to be fierce. She seems on the edge herself. She lost her cool completely at the final weigh in, swearing and glowering at Alison Sweeney, the usually sweet host. Alison seemed unprepared and inarticulate, but the whole scene just confirmed the soap opera status to which this show has sunk. At least Alison is back in her milieu.

As if we hadn't suffered enough, we did not get the satisfaction of anyone being eliminated! Ooh...that's for next week...we're on the edge of our seats.

So here's what was really lost this week on The Biggest Loser:

storyline (this was weak to begin with; now it's gone completely)

focus on weight loss (remember when that's what this show was about?)

direction (no one is in charge)

patience (even the trainers are at the end of their ropes)

sense of humor (ours, not theirs)

And oh yes...actual weight loss? Not so much. Not figuring very prominently anymore in this show. It's true that a couple of the men have lost over 100 pounds each. That's remarkable. And we applaud their commitment and results. But that's a tiny part of the show. More time is spent on Extra gum than on significant weight loss.

C'mon NBC. Wake up and get back on track. You don't have much time to lose. Nor much of an audience either.

(c) NBC Universal.

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The Biggest Loser - Couples: All for One, One For All

noreply@blogger.com (Nancy Davis, Safety4Kids) — Wed, 05 Mar 2008 18:16:00 +0000

And everyone for that vending machine!

Oh what a night. A boring, boring, boring night. This show is so far off track it's hard to know what to say anymore. Let's just say The Biggest Loser-Couples is having an identity crisis. As we've mentioned in our previous posts, this show is no longer about weight loss, exercise and achieving better health. Not that these things are not important to the contestants; they're just not important to the producers.

Yes, we went with everyone to the doctor and were impressed with the results of their hard work--they've all been "upgraded", medically, from "critical" to "fair". It is genuinely good news and very encouraging. And as we revisited their early medical appointments, we were reminded of their astounding progress. So why isn't that enough? Roger reached a milestone last night of 100 pounds lost. Dan is at 99. Not dramatic enough television?

Instead we watched each contestant face a vending machine filled with snack food, shameless product placement gum, and rewards including cash and "one pound pass" cards to be used at the weigh-in. If they hit the wrong combination of letters and numbers, out dropped a Twinkie and they had to eat it. Honestly, is this appropriate for a show that used to be about weight loss? The lucky ones got the shameless product placement gum and the cash. The unlucky ones ate over a thousand calories worth of trans fats. It was ridiculous.

The challenge had each contestant fly over a canyon on a zip line, pulling off flags along the way. This is where the identity crisis really took hold. Now the show is part Amazing Race, part Survivor, part Queen for a Day. Uh-oh. Showing our age. Google it if it doesn't ring a bell.

The one shining light in all of this was Bernie. Sweet, bandana-clad Bernie. Bernie and Brittany, you may remember (if you are able to stay awake for the full two hours each week), is the lone couple who began this journey as strangers. Early on we suggested that this fact could prove beneficial. And it did. They were the last couple standing intact. And they have been the two people genuinely and consistently cheering for each other and supporting each other through...well...thick and thin. So when Bernie won "Biggest Loser of the Week" last time and claimed his reward, he chose "game play" and was given the opportunity to grant immunity to any contestant on either team, just not himself. And rather than "play the game" and offer this great gift to someone in an effort to improve his own chances, he selflessly awarded the prize to Brittany, because they're partners and friends and he wanted to be sure she would live to play another week. As it turned out, in the words of Elfaba from "Wicked", "no good deed goes unpunished" and so Bernie was eliminated. And the "big twist" at the end was that there are no more teams--it's every one for themselves now. This will likely have the biggest impact on Bob's blue team of macho men, who still high-five and cheer "pride" after every workout.

We're glad this season has passed the halfway mark. We desperately hope that next season will see a return to one hour episodes focused on exercise and healthy eating, support and encouragement. In other words, we're hoping for a miracle. But hey, you gotta believe, right?

(c) NBC Universal.

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The Biggest Loser--Couples: Pride Goes Before the Fall

noreply@blogger.com (Nancy Davis, Safety4Kids) — Wed, 27 Feb 2008 11:35:00 +0000

And evidently, before the tattoo! Last night we watched four grown men go from macho-frat-boys in Vegas, to sniveling-melodramatic-wrecks in just two hours. What does any of this have to do with serious exercise and weight loss? Absolutely nothing. Which is the biggest problem with The Biggest Loser.

Last week the younger of the brother duo on Bob's blue team, Jay, was the biggest loser of the week. He took the customary walk up the mountain to find the three envelopes awaiting his choice, and he chose envelope three, which held a card that read "Vegas, Baby, Vegas". He quickly learned that he had won an overnight to Vegas for his entire team. The news was a welcome and surprising gift, until Bob rained on their parade, wishing he could stop them. He was afraid, of course, of all-you-can-eat buffets, being away from the gym and losing focus. The whole show has lost focus, so they might as well be in Vegas!

Anyway, in their usual style, the blue team talked, determined to stay on course and to win the weigh-in again, regardless of the temptations in Vegas; after all, they had kicked some serious butt last week, and that was after spending an entire week at home. They were not worried, simply looking forward to a boy's overnight. Unfortunately, we had to go along for the ride.

Side note: Why did we have to listen to Dan playing the guitar and singing? We get that he is the young, long-haired, Dan-cam-toting dude. But spare us the musical interludes, please? We have enough to endure.

Dressed like the gentlemen of Ocean's Eleven (courtesy of the suits provided by Bob), the four members of the blue team strode handily from gym, to casino, to healthy meals to the tattoo parlor. Tattoo parlor? Each of the team members got a tattoo featuring the word, "Pride", which is what they all shout after placing their hands together, one atop the other, in their unified pre-and-post challenge rallying cry. Full of bravado and male bonding, we watched as the four team members permanently etched their skin. Bob, you no doubt have noticed, is covered in tattoos. We're guessing this is the point at which Jackie is actually pleased she got eliminated from the team.

Long story short. They had a blast in Vegas, and came back to the ranch and won the challenge, which was all about brute strength, which to us is enormously unfair at this point. The black team is made up of three women and Bernie, who is a small (by these standards) man. The blue team is four big guys. Last night's challenge was a snap for the blue team and each team member won a trip for two to Puerto Rico. First Vegas, now Puerto Rico. This team was pumped. Dan described them as "unstoppable." Until the weigh-in, that is.

Jillian's black team had worked very hard all week in hopes of increasing their numbers at the weigh-in. They did not want to have anyone eliminated, because they already feel fairly disadvantaged by the difference in the physicality of the teams. Women have a much harder time losing weight, and their numbers demonstrate that week after week. But Jillian pushed them very, very hard and it paid off. The black team won, and Mark, the central figure of the blue team, the older brother and devious game-player, lost only one pound. Oops. Maybe not so unstoppable after all.

Roger reminded Mark that he had promised to leave voluntarily if he hit a wall with his weight loss. Mark fought back, trying to wiggle out of that commitment, but in the end, he had a crisis of conscience and told everyone, including his brother, to vote him off. To say that the last twenty minutes of the show was unbearable is an understatement. Crying, hugging, vowing eternal brotherhood, more crying, long and dramatic speeches. And then it was over. And Mark was gone. Leaving Brittany and Bernie of the black team, the only intact team from the beginning. And they are the two that were strangers when it all began.

How will Jay do without his overbearing older brother?
Will the blue team regret those tattoos?
Will Mark come back the winner of the voted-off biggest loser competition?
Will Dan actually learn to play guitar?
Will we care about any of this?!

We still cheer for the contestants and their accomplishments. And while Mark has never been our favorite, he has demonstrated the greatest change physically and his determination will no doubt carry him further on his weight loss path. We wish them all luck.

But we long for a simpler time. When the show was an hour. When the focus was weight loss and how best to achieve it. When the contestants cheered for each other rather than conspired to "play the game" only to win the money and the weekly prizes. When Bob and Jillian were trainers, exempt from the melodrama.

Sigh. What's been lost from this show is more than weight; it's lost its soul.

(c) Photos courtesy NBC Universal.

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Technorati Tags: weight loss, Biggest Loser, reality show, fitness, diet

The Biggest Loser-Couples: Better to Have Loved and Lost?

noreply@blogger.com (Nancy Davis, Safety4Kids) — Wed, 20 Feb 2008 11:58:00 +0000

Last night was not a good night for Paul. He seems to have suffered a setback not only in his weight loss, but in his emotional loss as well. Paul, you remember, teamed up for this show with his ex-wife, Kelly. Together they have experienced quite a roller-coaster journey on The Biggest Loser, but Kelly has been a key reason that Paul has consistently "put up good numbers" as they say in "weigh-in" jargon. Kelly, along with Jillian, helped motivate Paul and reminded him why he was there and why he had to get healthy, literally to save his life.

But last night's episode was very revealing: reality TV met reality, as the contestants were sent home for a week to see how they would fare in the real world. Away from their trainers, the gym, their partners and new friends, and the kitchen that is stocked with only healthy, approved food items. The results were dramatic.

Bob's blue team, who have spent the previous two weeks facing elimination, had been humiliated and demoralized by their consistent loss (not the good kind), both in the challenges and on the scale. So they left the campus with strong determination to continue their progress at home and to come back and post significant weight loss. They did not want to go to the elimination room again. It's also worth noting that while Bob provides support and oversight, he is not as connected to his team emotionally. These four macho guys are very independent and self-motivated.

Jillian's black team, by contrast, had been eking out just enough weight loss to win the weigh-ins, but they seem especially dependent on Jillian for the push that makes the difference. Jillian, you may remember, forces her team to face their emotional dependencies on food and has created strong bonds with each of the members of her team. As a result, Jillian called each of her "people" when they were home, twice a day, to check on them and remind them of their goals and potential pitfalls. Of all the members of the black team, only Paul refused to speak with Jillian while home. This proved a tragic mistake.

The homecomings were interesting and touching and some people, like Mark, the overbearing control freak who has been at the center of much of the controversy on campus, immediately pulled donuts out of the mouths of his children and threw away everything in the house that could prove a temptation. His kids were crying, his wife was surprised, but he was determined to go back to campus a winner. Uh, a loser. This is where it gets confusing.

Mark also pushed his brother Jay, both of whom live outside of Boston, and while this sometimes annoyed Jay, he listened to his older brother. After last week's episode, where the blue team lost the weigh-in by a pound, Jay, who had the lowest weight loss felt entirely responsible. So he was also very determined to do well while home. This determination, coupled with what they learned on campus, proved a powerful combination. Jay lost the most weight of anyone and at the weigh-in, Bob's team demolished Jillian's team and for the first time in weeks, the black team headed to the elimination room.

Paul, marked for elimination for a variety of reasons, including his own defeatist attitude, was sent home. This leaves Kelly alone on what used to be the yellow team.

Paul. A big guy with a lot of emotional issues, many of which were exposed on the show. But perhaps the biggest issue was that he was still in love with Kelly, his ex-wife and partner on The Biggest Loser. So as long as Paul was with Kelly, he rose to every challenge, lost a lot of weight, and kept the promise he made to himself to get healthy and live longer than his father lived. But as soon as he went home, his unhappiness made him vulnerable to his emotions and his loss, and he ate three massive plates of buffalo wings, large glasses of soda, and mountains of cake. He also refused to answer or return Jillian's calls. And in that scene at the very end of the show, where we get to see how the eliminated player is doing, we learn that Paul came down with double pneumonia as soon as he got home and actually gained six pounds.

We don't have a lot of hope for Paul. His issues are deep and his coping mechanisms are not exactly finely honed. He has a long way to go.

So the question remains: is it really better to have loved and lost? In Paul's case, we're not so sure. But we wish him luck and hope that he makes healthier choices now that he's home.

(c) NBC Universal.

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Technorati Tags: weight loss, emotional eating, love, marriage, The Biggest Loser, couples