For those who don’t know, House is an excellent TV show on Fox, which stars Hugh Laurie as Doctor House, a genius at diagnosing tricky diseases who is also selfish, rude and obnoxious to the point of minor sociopathy. Apart from the fascinating character, devious plot lines and a pithy script, one of the things I admire most on the show is Laurie himself. American audiences may not know (especially given his stellar mid-Atlantic accent) that he is an English actor known primarily on the other side of the pond as a comedian. But I digress.
Every week in the show, House is presented with one or more puzzling cases where the immediate diagnosis is not clear. Over the course of the hour long episode, the patient(s) typically present more and more mystifying symptoms, with his/her/their condition deteriorating until they are close to death, before House has a Eureka moment and pulls the correct diagnosis out of the hat like a rabid bunny.
Let us consider then, the strange case of Patient A, a 38 year old woman in apparently good health with no obvious risk factors. In January of 2006, Patient A is diagnosed with hypothyroidism, which is treated with levothyroxine in standard dosage. All seems well until September 2006 when Patient A suffers a Transient Ischemic Attack and is hospitalized. After undergoing countless tests which all prove normal Patient A is released, but in follow up testing a Trans Esophagal Echo determines the presence of a 5 mm Patent Foramen Ovale (Hole in the Heart). Further testing demonstrates that this PFO is Grade IV and Patient A is told she will probably need to have it closed. Meanwhile Patient A has stopped taking the Birth Control Pill Yasmin and is suffering horrible symptoms from hormonal fluctuations including dizziness, palpitations, restless leg syndrome, insomnia etc. The abrupt cessation of hormones has also led to Patient A experiencing acute abdominal pains during her menstrual cycle. She reports these to her doctor, concerned that the pains might be indicative of endometriosis, the presence of which has been masked by the pill. An ultrasound followed by an MRI in early 2007 determine that Patient A’s left ovary has in fact been entirely taken over by a Dermoid Cyst, which will need to be removed. Surgery is tentatively scheduled for late February.
On February 13th 2007 Patient A finally gets in to see the Cardiologist at Jefferson Hospital. He appears concerned by an anomaly in her charts no one else has picked up on previously, namely an irregularity in the right vertebral artery. He decides she needs conventional angiography to evaluate this before proceding with the PFO closure, and also that the ovarian surgery cannot proceed until more is known, because of the risk of taking Patient A off the blood thinner (standard aspirin, 325mg per day.)
Oops. This particular episode appears to have run over an hour, and no one can find Doctor House to deliver the masterful diagnosis. I guess we’ll have to slap up the “To be continued” sign.
I wonder how Patient A is feeling about all of this. Would anyone like to take a guess?