This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)

Photo by Fox

Photo by Fox

Danger level: Medium

What is it

Syringomyelia is damage to the spinal cord caused by a fluid-filled area (a cyst, which is called a syrinx). The syrinx usually appears first in the neck, and later extends upwards or downwards – putting pressure on other areas of the spinal cord.

Who gets it

Syringomyelia is not common – the frequency in the US is 8.4 cases per 100,000 people. The disease usually appears around the ages of 20-40, and men get it more than women.

What causes it

The fluid inside the syrinx is called Cerebro-Spinal Fluid (CSF) – this fluid can be found normally around and inside the brain and spinal cord. A syrinx is formed when there is a problem with the circulation of this fluid so there’s too much of it in a specific area inside the spinal cord. This might happen for several reasons, including birth defects (which are the most common reason), trauma to the spinal cord (like in the House episode), a tumor in the spine or inflammation of the spine.

How does it feel

The symptoms usually develop slowly and appear gradually:

• Muscle problems, including muscle weakness in the arms and legs, loss of muscle mass and contractions or  muscle-spasm in the legs.
• Sensory problems – decreased sensations (of pain, temperature and touch), numbness or pain. These problems are more common in the neck, shoulders, arms and trunk (a “cape-like” pattern).
• Headaches.
• Problems with bowel and bladder function.

How is it discovered

If you have symptoms of syringomyelia, the doctors will start with a neurological exam (checking muscle strength and sensation) which will help them to estimate where the problem which causes the symptoms is located. In order to prove that there is a syrinx and show it, the doctor will perform an MRI of the spinal cord.

An MRI of syringomyelia. The syrinx is the white area inside the gray spinal cord. Photo by Cyborg Ninja

How is it treated

When there are symptoms, the treatment is surgery to drain the fluid from the syrinx. Sometimes a tube is inserted for continuous draining. After surgery, physiotherapy can help restoring function in the damaged muscles. If there are no symptoms, treatment is not necessary.

What happens after treatment

The surgery stops the progression of the syrinx so new symptoms will not appear. Also, about half of the patients report significant improvement in the symptoms they had.

Without treatment the disease gets worse and worse and eventually causes severe disabilities.

The bottom line – how do I avoid it

There is no way to prevent syringomyelia – the most important thing is to catch it on time before the symptoms cause disabilities.

Related posts:

1. As Seen on Grey’s Anatomy – Tethered Spinal Cord Syndrome
2. As Seen on Grey’s Anatomy – Normal Pressure Hydrocephalus (NPH)
3. Teratoma–When You Can Find Teeth and Hair Inside Your Body (As Seen on House MD)

This is part of our House MD Project series.

On episode 22 of season 1, named “Honeymoon”, House agrees to treat his ex-girlfriend Stacy’s husband Mark, who has been suffering from abdominal pain, paranoia, mood swings, and regression. He has also passed out twice.

Later in the episode we learn he has switched from mountain biking to home yoga. He also develops a paralysis and has delusions.

Photo by Fox

This all leads to a diagnosis of acute intermittent porphyria. We’ve already covered this topic in the past (on another TV show – Grey’s Anatomy). You can read about the disease here:

As Seen on Grey’s Anatomy – Acute Porphyria

Related posts:

1. As Seen on Grey’s Anatomy – Acute Porphyria
2. Myasthenia Gravis Revisited (As Seen on House MD)
3. Necrotizing Fasciitis Revisited, Osteosarcoma, and Aneurysms – (As Seen on House MD)

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On episode 15 of season 1, called Mob Rules, a mobster named Joey arrives at the hospital with a coma, from which he comes in and out to repeatedly. It turns out Joey has ornithine transcarbamylase deficiency, a disease causing him to not being able to digest red meat. On a side note the team also discover he has hepatitis C (an infection transferred either by needle sharing or homosexual activity) and that he has a high estrogen level in his blood, caused from a drug used to suppress libido. The last two facts lead house to the conclusion that he is also gay.

Danger level: High

What is it?

Ornithine transcarbamylase deficiency (OTD) is a rare genetic disorder causing a problem with eating protein.

Who gets it?

OTD is a rare condition – it affects about 1 in every 80,000 people. The condition is genetic, meaning it is passed on in families. It also usually happens to males, due to the mode it is inherited.

Usually the condition becomes apparent in the first few days of life. Sometimes, though (like in the House episode), the condition can manifest later in life.

What causes it?

We live and function thanks to millions of reactions that happen in our body each day. One of those reactions happen inside a cycle of reactions called the urea cycle.

The urea cycle. Drawing by Yikrazuul

The urea cycle is a sequence of reactions that happen in our liver cells. It processes excess nitrogen, which is generated when our body uses protein. In order to get rid of the excess nitrogen, the cycle turns it into urea, which the kidneys can get rid of in our urine.

Each of the steps in the cycle happens through the action of a special machine, called an enzyme. In OTD, one of those enzymes is damaged or missing. Since the body can’t get rid of the excess nitrogen, it is accumulated in the body, turning into a dangerous substance called ammonia.

Ammonia is dangerous for our nervous system and so the condition causes neurological problems. The excess can also damage the liver.

How does it feel?

The condition, as we mentioned above, usually becomes evident in the first days of life. The baby will be lacking energy, vomit, or refuse to eat. Its breathing rate and body temperature will be poorly controlled. Sometimes seizures can occur, and even a coma is possible.

In adults the symptoms aren’t very different. They can include loss of appetite, irritability, heavy or rapid breathing, weakness, vomiting, disorientation, sleepiness, and also coma and death. (Remember that the guy on the House episode had recurrent comas).

How is it discovered?

A blood test is done which shows that the person has too much ammonia in their blood. There’s also a test done on a urine sample that can give a clue to the condition.

Also, a genetic test can find out if the person has the defective gene (although it doesn’t work all the time).

How is it treated?

Since the body can’t handle large amounts of nitrogen (it can’t turn it into urea like it normally should), the treatment includes measures that lower the amount of nitrogen in the body.

This includes not eating lots of nitrogen (protein is very nitrogen-rich. That is why a low-protein diet is subscribed. Remember the mobster in the House episode couldn’t eat steaks?).

Treatment includes saying goodbye to steaks. Photo by FotoosVanRobin

Treatment also includes lots of food and water when a person is ill (since otherwise the body tends to break down its own protein at these times) and some medications that can lower the nitrogen in the body.

What happens after treatment?

The baby’s brain can be damaged from the disease (by the ammonia) if not treated on time. It’s important to catch the disease on time, and then to keep with the strict diet throughout life.

The bottom line – How do I avoid it?

As with other inherited diseases, you can’t really prevent it once the person is born with a defective gene. Parents that know they carry the defective gene and can transfer it to their children can use genetic testing to test if the developing embryo has the defective gene (a process called preimplantation genetic diagnosis).

Related posts:

1. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency – When Certain Conditions Can Destroy Blood Cells
2. Iron Deficiency Anemia – A Common Type of Anemia
3. Toad Venom Poisoning – If You Eat Certain Sea Foods You’d Better Read This (As Seen on House MD)

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On episode 10 of season 1, called Histories, a homeless woman named Victoria arrives at the hospital after being found in a rave party. She presents with a seizure, hand twitches, a fever, a fear of light and water and insensitivity to touch in an area on her body. Combining the clues the team arrive at the conclusion that she has rabies.

Danger level: High

What is it?

Rabies is an infection caused by a virus, which affects the brain and the spinal cord.

Who gets it?

Since, as you’ll read here, there’s a vaccine for rabies, nowadays humans are rarely affected in developed countries. In the US, between 1980-2003 there were about 40 cases of human rabies. In the rest of the world, unfortunately, there are many more human infections – as many as 55,000 people die of rabies each year. 56% of them in Asia and 44% in Africa.

What causes it?

The rabies virus can infect animals such as bats, raccoons, skunks, dogs, foxes, and coyotes. The virus then lives in the animal’s saliva and is transmitted through biting or scratching.

In the US it is usually spread by bats. In other countries, stray dogs are more commonly the cause of infection.

The infected animal will behave weird – it may act shy although it’s usually friendly, or have no fear of humans when it’s wild. It may also drool, foam at the mouth, or show signs of paralysis. When the infected animal bites or scratches a human, the virus can be transferred and infection occurs. The risk of getting rabies is greater if the person is bitten more than one time, or if the bite is close to or on the head.

A dog with rabies.

How does it feel?

The first symptoms look as if you have the flu – they contain fever, cough or a sore throat. Later other symptoms appear, including agitation, anxiety, confusion, difficulty swallowing, excessive salivation, fear of water (called hydrophobia – it’s caused because of the difficulty in swallowing), hallucinations, trouble sleeping, partial paralysis. And eventually, coma and death.

It’s important to note that once symptoms appear, it’s too late for a cure. Still, you have time from the bite to get a cure – the time from exposure to the virus until symptoms appear is usually 2-3 months (although in rare cases it may be shorter or longer).

How is it discovered?

Although there are ways to make sure someone bitten has rabies, the doctor comes at the conclusion you have rabies by the story, since no time can be wasted.

The virus can be discovered by taking a sample of saliva, of spinal fluid, or of tissue from our nervous system. Although a blood test can also discover rabies, it’s usually only positive later in the disease.

How is it treated?

Wound cleansing and immunization done as soon as possible after a contact with an animal can prevent the onset of the disease in virtually 100% of cases.

If you think you’ve been exposed to rabies, first wash the animal bite or scratch with soap and water. Then call your doctor and local health department right away.

Then comes decision time:

• If the animal that beat you has a low chance for having rabies (such as a pet) – The animal will be captured and watched for signs of rabies. At that time the doctor may not want to wait until symptoms appear in the animal and you may get a series of shots against rabies.
• If the animal has a high chance for having rabies (such as a bat or a wild or stray animal) you will start getting the shots right away. If possible, the animal will be watched for signs of rabies or will be killed for testing. If the animal is found to not have rabies, you can stop getting the shots.

What happens after treatment?

As mentioned above, the disease is curable if treated on time. If, on the other hand, no treatment is given, it is nearly always deadly.

There are a few things you can do to prevent rabies:

• Have your pet dog, cat, or ferret, vaccinated against rabies.
• Avoid any contact with bats.
• Don’t touch or pet wild animals (such as raccoons, skunks, foxes, coyotes).
• Don’t handle a dead animal.

Related posts:

1. Echinococcosis – How Even Your Cat or Dog Can Infect You With Worms (As Seen on House MD)

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On season 1 episode 9, named DNR, John Henry Giles, a famous trumpet player, loses his breath in the middle of a musical session. Dr. House is more intrigued by the patient being paralyzed and doubts a previous diagnosis given to him of a disease called ALS. Turns out House was right, as always, as it’s discovered by the end of the episode that the patient had arteriovenous malformation compressing his spine, which caused his paralysis.

Danger level: High

What is it?

Arteriovenous malformation (or AVM for short) is a defect in the blood vessels causing an abnormal connection between veins and arteries.

Who gets it?

AVM isn’t very common, and not much data exists about who gets it. It is known, though, that in the United States about 300,000 people have it.

It usually occurs in young adults, even though the origin of the disease goes back to being a fetus.

What causes it?

To understand what AVM is, you first need to understand the basics of blood vessels in the body.

Our circulatory system (the system through which blood is delivered to organs in the body) is composed mainly of arteries and veins. Arteries (appearing red in the drawing below) carry oxygen-rich blood to our organs. Arteries divide into smaller and smaller arteries until the become the smallest blood vessels, called capillaries.

Capillaries join together and form veins (appearing blue in the drawing). The veins’ role is to take up waste products from the organs.

In AVM, defects in the circulatory system cause direct connections between arteries and veins, without the capillaries in between. When these happen in our nervous system (the brain or the spinal cord), 3 things can happen that lead to problems:

1. Hemorrhage – Due to the defect, blood can spill from the vessels to the surrounding area, including the brain (if the AVM is in the brain).

2. Seizures – Again, if the AVM is in the brain.

3. Neurological defect – A defect in the brain or spinal cord functions can happen and advance over months and years. This is what happened on the House episode.

Why does these happen? No one knows for sure. It may be because the area with the AVM “steals” blood from the normal blood vessels. Or because the AVM presses on the area outside of it.

(Remember that AVMs can occur anywhere in the body. In this article we deal with the nervous system simply because the House episode showed an example of this location).

How does it feel?

Most people don’t even know they have AVM, since no symptoms appear.

When they do appear, symptoms can include persistent headaches or seizures. If the AVM bleeds, it can cause a very severe headache and a stroke or even death.

When the AVM presses the surrounding area it can cause neurological problems depending on the area of the brain or spinal cord it’s located at. In the House episode, for example, it caused paralysis.

How is it discovered?

A CT scan or an MRI are used to discover AVMs. An angiography (a technique used to image the inside of blood vessels) of the area can also be used.

An angiography showing AVM in the brain. Photo by Dr Marina-Portia Anthony

How is it treated?

AVMs are treated by a surgery, by irradiation of the AVM, or by a process called embolization. In embolization, the doctor plugs the AVM by inserting a coil or glue that will block off the area.

What happens after treatment?

Without treatment, 2-4% of AVMs will bleed each year. Treatment should stop these complications from happening.

Since you are born with AVMs, there is no known way you can avoid it.

This video shows how dangerous AVMs can be through the story of Amit, who had headaches which were first thought to be flu-related:

httpv://www.youtube.com/watch?v=IZGxW9RQQzk

Related posts:

1. Wegener’s Granulomatosis–A Rare Inflammation in Blood Vessels that Can Lead to Death (As Seen on House MD)
2. Blood Clotting Tendency (Thrombosis) – Are You at Risk? (As Seen on House MD)
3. Peripheral Arterial Disease – A Narrowing of Blood Vessels that Will Shorten Your Life

On the last episode of Grey’s Anatomy (which, we know, was two weeks ago – sorry for the delay) Dr Bailey recalls a case in her intern year that helped her become the doctor she is today.

The patient presented in the episode had chronic pain and she’s been through many surgeries, including having her ovaries removed, but nothing worked. That led Dr Bailey (then called Mandy) to the diagnosis of porphyria.

Danger level: Medium

What is it?

Porphyria is a group of diseases resulting in the buildup in the body of materials called porphyrins and related materials, leading to abdominal pain, constipation and muscle weakness.

There are 2 types: Acute porphyria and cutaneous porphyria. We will discuss acute porphyria here.

Who gets it?

Acute porphyria is quite rare – it happens to 1-5 people out of 100,000 in the US. Outside the US it can be much higher: in Sweden, for example, it happens to 60-100 people out of 100,000.

It affects women 1.5-2 times more than it affects men. It usually happens around ages 18-40.

What causes it?

Our body produces a substance called heme. It can be found in all of our body, but mostly in red blood cells, our bone marrow and our liver.

Heme is created in our body out of materials called porphyrins. In the body, the machines that are responsible for converting materials from one type to another are called enzymes. In acute porphyria, one of these enzymes is defective, meaning that instead of converting to heme, porphyrins accumulate in the body.

The problem with the enzyme is usually genetic, meaning you inherit it from your parents.

Having the defective enzyme isn’t always enough. People with the defect might not have any symptoms, a condition which is called latent porphyria. Sometimes, though, there are triggers in the environment which call our body to produce more heme – meaning it will need extra-action from the enzyme. In this case, the symptoms may begin.

Examples of such triggers:

• Certain drugs – Such as some forms of antibiotics, but even birth control pills.
• Surgery
• Stress
• Smoking
• Dieting/fasting
• Infections
• Alcohol use
• Sun exposure
• Excess iron in the body

How does it feel?

Acute porphyria mainly affects our nervous system (we mentioned above another type – cutaneous porphyria – this type affects mainly the skin).

What does a person with acute porphyria feel?

• Abdominal pain
• Constipation
• Vomiting
• Diarrhea
• Pain in the arms, legs or back
• Muscle pain, tingling, numbness or paralysis
• Seizures
• Fever
• Confusion
• Hallucincations
• Disorientation
• Paranoia
• Red urine
• High blood pressure

How is it discovered?

There are several ways to discover when someone has porphyria:

1. Urine test: In it, the high level of porphyrins in the body will be shown.
2. Stool test: Sometimes porphyrins can be detected in the feces better than in the blood.

How is it treated?

There are several ways to treat this condition:

1. Hemin or hematin: This is a form of heme that the doctor injects to your body. This way the body will have enough heme and not try to create more of it (which in this disease will lead to more porphyrins accumulating).
2. Stopping any triggers: Such as medications that may have led to the condition, or an infection.
3. Intravenous sugar (glucose) – Can also inhibit the body’s need to produce heme.
4. A high-carbohydrate diet – Forget Atkins. This is true only for attacks of the disease, not between them.
5. Pain killers 

What happens after treatment?

Porphyria is a life-long disease with symptoms that come and go, more in some people, and less in others. Avoidance of triggers can help reduce the time between attacks.

The bottom line – How do I avoid it?

You can’t prevent having the disease itself (it’s genetic). But if you know you have it, taking the following steps may help avoid attacks:

1. Avoid medications known as triggers (consult your doctor about this)
2. Don’t use alcohol or illicit drugs
3. Avoid fasting or dieting too heavily
4. Don’t smoke
5. Minimize sun exposure. When outdoors, wear protective clothing and use sunscreen.
6. Treat infections promptly.
7. Reduce stress

Family members of people with porphyria are advised to undergo genetic testing, to discover if they have the defect themselves.

Related posts:

1. Acute Intermittent Porphyria Revisited (As Seen on House MD)
2. Acute Pancreatitis – A Dangerous Condition Which Can Be Caused by Drinking Alcohol
3. Acute Pericarditis – Inflammation of Your Heart’s Covering

Head spinning is a common complaint in medicine. The main problem with head spinning is actually its definition: People often confuse it with dizziness. When someone comes to the doctor complaining “I feel dizzy”, it usually means one of two things: Either they feel their head is spinning, or they feel they are about to faint.

In this article we’ll cover the first option – head spinning, or in medicine “vertigo”. When you have vertigo you feel as if you are spinning or the world is spinning around you, when there is no actual movement.

Vertigo. You feel as if the world is spinning. Photo by Melle_Oh.

Why is vertigo caused?

3 systems are responsible for our body’s balance:

1. The eyes – For example, if you don’t see where you’re going, you will fall.
2. The somatosensory system – That’s a complicated name, but what it means is that our skin, joints and muscles are constantly sending information to our brain telling it where we are in space.
3. The ears – Our ears have two main parts: The one responsible for hearing, and the one responsible for balance.

Vertigo is usually caused by a problem in the part of our ear responsible for balance (that part is called the vestibular system).

Our ear from the inside (the inner ear). This part is responsible for our balance, and for vertigo.

What are the causes?

A bunch of diseases can cause vertigo, but it can also occur to normal people:

1. Seasickness – We mentioned above that 3 systems in our body tell it where we are in space. Sometimes these systems send different messages to the brain, getting it “confused” – such as when we’re at sea. When we’re at sea, our inner ear will feel the movement from the waves. At the same time, our eyes will tell the brain we’re not moving (since we’re just sitting in our cabin). This confusion leads to seasickness (also called motion sickness).This mismatch between our systems also explains why we have carsickness, fear of heights, and the vertigo some people feel when watching chase scenes in a movie.
2. Unusual neck or head positions – Such as when we paint a ceiling – our necks would be extremely extended, a position to which we are not used.
3. Following a spin – Ever tried to spin on a spinning chair? Most likely after that spin you felt as if the world was spinning around you.

As mentioned above, there are also diseases which cause vertigo:

1. Problems in our inner ear -
   a. Meniere’s Disease – This is a condition in which there is a problem with the fluid inside our inner ear. This causes vertigo, ear ringing and hearing loss.
   b. Benign paroxysmal positional vertigo (BPPV) – In this condition brief vertigo spells that come and go are caused by changes in the position of the head.
   c. Labyrinthitis – This is caused when there is inflammation inside our inner ear. It’s mostly caused by a virus.
2. Migraine headaches – About 25% of people with migraines have some sort of “dizziness”, which can sometimes manifest as vertigo.
3. Stroke – Stroke happens when the blood supply to the brain is disturbed. When the blood supply to the area of the inner ear and our brainstem is disturbed, vertigo can occur. This is a life-threatening situation.

There are other diseases which can cause vertigo, but these are the most common ones.

In the future we will cover each disease mentioned here, so you can return to this page or bookmark it to learn about each of them.

Ever experienced vertigo yourself? Let us know in the comments.

Related posts:

1. Meniere’s Disease – From Head Spinning To Hearing Loss
2. Labyrinthitis – An Ear Infection Causing Loss of Balance
3. The 5 Most Popular Posts in June

Danger level: High

What is it?

Neuroblastoma is the most common cancer in infants. Cancer forms here in the adrenal gland, neck, chest or spinal cord.

Who gets it?

1 in 100,000 children will get neuroblastoma. Two thirds of cases of neuroblastoma occur in children younger than 5 years. After age 10 the disease is rare.

This cancer is a little more common in boys than girls, and more common in white people.

What causes it?

There is a part of our nervous system which is called the autonomic nervous system. This part controls functions of our bodies, such as the heart rate, breathing, blood pressure, digestion and other things.

The autonomic nervous system is divided in to the sympathetic system and parasympathetic system. Neuroblastoma arises from the sympathetic system. The sympathetic system includes -

1. Nerves that run alongside our spinal cord
2. Clusters of nerves along nerve fibers in our bodies, called ganglia
3. Nerve-like cells in our adrenal glands (small glands that sit on top of our kidneys).

Since neuroblastoma develops from the sympathetic system, it can be found anywhere along this system. About 40% start in the adrenal glands. Another 25% in ganglia in the abdomen, and the rest in ganglia in the chest, neck or pelvis.

The autonomic nervous system. You can see it controls many organs in our body – The heart, eyes, intestines and others. Neuroblastomas arise from the sympathetic system.

The cause for the rise of tumor from these types of cells isn’t known.

How does it feel?

Neuroblastoma may begin with symptoms that are not specific, such as loss of energy, loss of appetite, fever. Other symptoms depend on where the tumor is located:

1. If it’s in the abdomen – It may cause a swollen belly, abdominal pain or constipation.
2. If it’s in the chest – It may cause breathing problems.
3. If it’s in the vicinity of the spinal cord – It may press it, causing weakness.

The tumor may also spread to the rest of the body and cause different symptoms, such as bone pain if it reaches the bones, or bulging eyes/dark circles around the eyes if it reaches behind them. About 50-60% of children already have metastases in other areas of the body by the time it is discovered.

Neuroblastoma can also release hormones, which cause different things in the body. Examples of these things:

1. Fever
2. Diarrhea
3. High blood pressure
4. Rapid heartbeat
5. Red skin
6. Sweating

How is it discovered?

There are several things that can be done to discover it:

1. Blood test – A high amount of the substances dopamine and norepinephrine are higher in this tumor. These substances are produced by the sympathetic system, and so are higher here.
2. Urine test – The substances found in the blood are broken down by the body into other substances, which are then passed out in the urine. They are called homovanillic acid (HMA) and vanillyl mandelic acid (VMA), and will be higher if a tumor exists.
3. X-rays, CT scan, MRI, ultrasound – They can discover the origin of the tumor in the body. A special scan called MIBG can discover the tumor areas in the body.
4. Biopsy – It’s the only way to be certain that all the hints we got from the other detection methods are really arising from a neuroblastoma. A piece of the tumor is taken out and viewed under a microscope.

How is it treated?

There are many options for treating neuroblastoma. Choosing a certain option depends on the age of the child, the level to which the cancer has advanced before discovery, the location of the cancer in the body, and the way it looks under the microscope.

The treatment can include surgery, chemotherapy, radiation, stem cell transplantation or other types of therapy.

What happens after treatment?

There are many things that can affect the survival of the child with a neuroblastoma, including age, the advancement of the tumor, the way the tumor looks under the microscope. Tumors which are less advanced respond better to treatment.

There is no known way to prevent neuroblastoma. In rare cases, the tumor can be found before birth during an ultrasound. It can also be found accidentally in children during tests to find other diseases. Such early discovery might improve survival (but there are currently no recommendations to search for the tumor in every infant, since this wasn’t found to be helpful).

You can learn more about neuroblastoma by reading the personal story of Paris, at The Strickland Family Blog.

Related posts:

1. Osteosarcoma–The Most Common Bone Cancer in Children (As Seen on House MD)
2. Common Variable Immunodeficiency (CVID)–When a Cold Can Threaten Your Life (As Seen on House MD)
3. Following Michael Douglas – Oropharyngeal Cancer – What Is It and How Can You Protect Yourself?