This is part of our House MD Project series.

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

On the first episode of season 8 (named “Twenty Vicodin”, and featuring an interesting guest in the cast!), House is in prison after crashing his car into Cuddy’s living room. One of the prisoners has a fever, joint pain and a rash on his thigh, and House convinces the prison’s doctor that he has lupus. Later, after the prisoner breaks his arm from a minor hit and doesn’t stop bleeding from a small cut, House listens to his chest and discovers an “acoustic shadow”, meaning there is a mass in his lungs. After drinking some coffee the prisoner develops a severe allergic reaction (anaphylaxis) which causes his airway to swell up and almost kills him. House then realizes that the reason for the reaction was the high temperature of the coffee and diagnoses him with mastocytosis

Photo by fox

Danger level: Medium

What is it?

Our immune system is composed of many types of cells and partןcles. Mast cells belong to the immune system and are involved mostly in allergic reactions. These cells produce substances that cause some of the allergy symptoms, the most famous of them is histamine. In systemic mastocytosis  the amount of these mast cells increases significantly, causing the disease.

This is how a mast cell looks. Photo by Ed Uthman

Who gets it?

Systemic mastocytosis is an extremely rare disease – so rare that it’s frequency in the population is not known. It’s a bit more common in men than women, and appears mostly in children, though it may happen to adults (and then the most common age is 55).

What causes it?

The disease develops when a mast cell starts dividing uncontrollably (like in cancer). Since the mast cells keep dividing, there are too many of them – and they can form a tumor, circulate in the blood or accumulate in organs. Also, substances that mast cells produce like histamine are released in larger amounts than usually. All these processes can cause symptoms.

How does it feel?

Symptoms can appear in any organ where mast cells accumulate. This can cause skin rashes, bone pain and problems with the liver, spleen or bone marrow.

Substances that are produced in mast cells and released in large amounts (like histamine) can cause itching, flushing and symptoms in the digestive system (for example: abdominal pain, diarrhea, peptic ulcers and problems with the absorption of food).

Another important symptom is severe allergic reactions (also called anaphylaxis) which can be dangerous and cause difficulty breathing or a very low blood pressure. The most severe allergic reaction in mastocytosis is to bee stings.

In some cases flushing and low blood pressure can develop in response to certain drugs against inflammation (like in the “aspirin test” at the end of the episode), and any symptom can be worsened by these drugs, alcohol or narcotics.

Mastocytosis in toddlers

How is it discovered?

The doctor can suspect mastocytosis based on the symptoms and blood work, but the only definitive test is a bone marrow biopsy, in which a bone sample is taken from the lower back. An important test which can support the diagnosis before performing the biopsy is measuring the levels of histamine in the blood or urine.

How is it treated?

There is no cure for mastocytosis. Treatment is aimed at reducing symptoms, and this is done mostly by different types of pills (for example, anti-histamines which are usually used for allergies).

What happens after treatment?

There are different types of mastocytosis which are dangerous in different levels. In some cases patients have the same life expectancy as the normal population, but in the more violent types (which are, luckily, more rare) patients survive for several months only.

The bottom line – how do I avoid it?

Unfortunately, there is no known way to avoid mastocytosis.

Related posts:

1. Sickle Cell Disease – When the Shape of Your Blood Cells Can Kill You (As Seen On House MD)
2. Astrocytoma (Butterfly Tumor)–A Brain Tumor That Spreads To Both Sides (As Seen On Grey’s Anatomy)
3. Pheochromocytoma – A Rare Tumor That Can Cause Hypertension (As Seen on House MD)

We usually go to the doctor when we don’t feel well or have a symptom that bothers us – and that’s how diseases are discovered most of the time. But – some diseases can be detected before having any symptoms, when they’re on their early stage. Screening tests are meant just for that and  are one of the best ways to protect your health – they are generally simple, performed routinely and can detect serious illnesses. Here ‘s a list of 10 important screening tests that you should know and consider taking.

Photo by Chandra Marsono

1. Colon Cancer Screening: Every person over 50 years old (or younger if a close relative had colon cancer, if they have IBD, or if they have certain genetic syndromes) should have colorectal cancer screening. The screening tests are aimed to find growths inside your colon, called polyps. Polyps have the potential to become cancer – but if detected early, they can be removed, preventing cancer. There are several ways to find polyps:

• Fecal occult blood (recommended once a year) is a simple stool test in which the feces is searched for small amounts of blood (that comes from polyps) which you can’t see on your own.
• During flexible sigmoidoscopy (recommended every 5 years) a short lighted tube is inserted to your rectum and looks for polyps on the lower third of your colon. During this procedure, polyps can also be removed.
• Colonoscopy (recommended every 10 years) is a similar test using a longer tube which can reach the whole length of your colon.

2. Mammography: A mammogram is a used for early detection of breast cancer – which is the most common cancer in women. This is an x-ray of the breasts, which can discover cancer when it’s still too small to feel it on your own. The test is recommended for all women between the ages of 50 to 74, and should be performed every 2 years. Besides that, it’s recommended for all women to have self-exams and clinical exams (by a doctor) of the breasts regularly.

On the left – a normal breast in mammography. On the right – a breast with breast cancer (white). Photo by National Cancer Institute.

3. Mole Exam: In this exam a dermatologist looks at your moles to see if any of them is suspicious to be skin cancer or melanoma. it’s recommended to have this check-up once a year. Besides that, you should try a self check-up every month – look for moles which are asymmetric, don’t have sharp borders, don’t have a constant color or are larger than 6mm (about a quarter of an inch).

4. Pap smear: This is a screening test for cervical cancer – the cervix is lower part of the uterus in women, and can be reached in a vaginal exam. It’s a simple test which is performed in your gynecologist’s office. During the usual gynecologic exam, the doctor will collect some cells from your uterine cervix and the area around it. Later these cells are check under a microscope and pre-cancer cells will be looked for. These cells can be also checked for a virus called HPV which causes cervical cancer. This test is performed once a year after the age of 21 or 3 years after the first time you have sex (whichever comes earlier).

5. Prostate cancer screening: The prostate is an organ that exists only in men. It’s small (about the size of a walnut), located under the bladder and in front of the rectum, and produces part of the semen fluids. Prostate cancer is the most common cancer in men. There are two screening tests for this cancer: a PSA test is a simple blood test to measure the levels of a substance called Prostate specific antigen (PSA) – which will be high in prostate cancer. Another important test is a digital rectal exam – this is done in your doctor’s office – the doctor inserts a finger to your rectum and feels the size and shape of the prostate. Currently there isn’t enough evidence supporting routine testing for prostate cancer, but you can ask your doctor if you should do one of the tests yourself.

6. Bone Density: The purpose of this test is to diagnose osteoporosis – a condition common in older people (mostly women) in which bones become thin and weakened, which makes them susceptible to fractures. This is a special x-ray picture which measures the density of bones in your hips, spine and wrists. Routine screening is recommended for women older than 65 years old.

7. HIV Test: HIV is the virus causing AIDS (Acquired Immunodeficiency Syndrome), which makes your body susceptible to life-threatening infections. It can be transmitted by having unprotected sex or sharing needles with someone who has the disease. The United States Center for Disease Control and Prevention (CDC) recommends that everyone get tested at least once in their life, and afterwards at least once a year if they had new sex partners since the last test (or their partner had sex with someone else), or if they are injecting drugs or steroids with used injection equipment.

8. Abdominal Ultrasound: This test’s purpose is to look for an aortic aneurysm. This is a dilatation of an artery so it looks like a balloon, causing the wall of the artery to become thinner so it might rupture. A common place for such an aneurysm is the abdominal aorta, which is a part of the largest artery in the body – you don’t want this one to rupture. A simple ultrasound test can discover an aneurysm. In the United States, this screening test is recommended for men between ages 65-75 who smoked in the past (or still are) or men above 60 years old with a family history of an aortic aneurysm. This test should be performed only once.

Photo by National Heart, Lung and Blood Institute

8. Abdominal Ultrasound: This test’s purpose is to look for an aortic aneurism. An aneurism is a dilatation of an artery so it looks like a balloon. This causes the wall of the artery to become thinner so it might rupture. A common place for such an aneurism is the abdominal aorta, which is a part of the largest artery in the body – you don’t want this one to rupture. With a simple ultrasound test (which can produce images of your abdomen without any radiation), the doctor can see if there is an aneurism. Sometimes the treatment for that will be surgery. In the United States, this screening test is recommended for men between ages 65-75 who smoked in the past (or still are) or men above 60 years old with a family history of an aortic aneurism. This test should be performed only once.

9. Routine blood tests: You should have a routine blood test once a year. This includes complete blood count (CBC) to check for anemia, fasting glucose levels – which is a screening test for diabetes, and cholesterol levels – high cholesterol raises the risk for heart diseases (and treating it can prevent them).

10. Routine Check-Up with your family doctor: It’s important to visit your family doctor at least once a year when you’re healthy. They will perform a physical exam, measure your blood pressure (high blood pressure doesn’t cause any symptoms but can be dangerous in the long run) and do an EKG (which is a test that checks the activity of your heart) – to look for various heart diseases. This is also a good opportunity to tell the doctor about symptoms or problems that bother you.

Here’s a summary of screening tests mentioned in the article. Find the ones that apply to you and make your appointment today.

Related posts:

1. Common Variable Immunodeficiency (CVID)–When a Cold Can Threaten Your Life (As Seen on House MD)
2. Crohn’s Disease – Inflammation in The Intestines Which Can Influence Your Whole Life

This is part of our House MD Project series.

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

On episode 2 of season 7 (named “Selfish”), Della Carr collapses during indoor skating for a charity event for her brother’s disease – muscular dystrophy (which causes muscle weakness). Apparently she had an arrhythmia (problem with her heart rate). While the team prepares her for a test to see if she has a syndrome that causes arrhythmias, they find out she stopped producing urine, which means her kidneys are failing. Later she also starts to cough blood, and a lung biopsy finds she has a lung disease called LAM. She undergoes a lung transplant but the new lung is failing soon afterwards. After House talks to her brother, he reveals that for a year she had non-specific symptoms like ear pain, chest pain, hoarseness and a runny nose. He then diagnoses her with sickle cell trait.

[house 702 photo]

Photo by Fox

Photo by Fox

Danger level: Medium

What is it?

Sickle cell disease is an inherited disease which affects our red blood cells. It causes them to stick to each other and interrupt the blood flow in small vessels, so less blood gets to the organs.

Who gets it?

Sickle cell disease is a genetic disease, meaning that people inherit it from their parents. There is a defective gene in the disease (called “hemoglobin beta-chain”). When a person gets two defective copies passed on from their parents (one from the mother and one from the father) they are sick and have sickle cell disease. If they only inherit one copy (from their father or mother) they are carriers, and their condition is called sickle cell trait.

Sickle cell disease isn’t very rare – one out of 625 people in the United States has the disease.

It’s much more common in Afro-Americans – 8% have the sickle cell trait, compared to only 0.24% of white people. It’s also common in Africa, Greece, Turkey and India.

It can affect men and women alike.

What causes it?

Our red blood cells carry oxygen and bring it from our lungs to organs in our body. It’s necessary for them to survive. The molecule in the red blood cells that’s responsible for carrying the oxygen is called hemoglobin.

The defect in the gene in sickle cell disease causes hemoglobin to be distorted, meaning the red blood cells get distorted as well. They look like a sickle (hence the name of the disease).

Normal and distorted red blood cells. Photo by NIH.

This causes the red blood cell to be sticky. The red blood cells stick to each other inside small blood vessels and clog them, and so less blood gets to the organs.

How does it feel?

Symptoms of sickle cell disease usually start when the baby is 6 months old. They include:

• Pain attacks (crises): This is the most common symptom. The pain can appear in the abdomen, bones, joints, and soft tissue. Each attack lasts for hours-days, it stars and ends suddenly. These crises are most common in small children . Some patients have lots of them and others have only a few or even none at all. Sometimes pain is accompanied by fever or general discomfort.
• Hand-Foot Syndrome: Swollen and painful hands and feet. This lasts 1-2 weeks and is common in very small children (6-18 months).
• Acute Chest Syndrome: Chest pain, fever, cough and difficulty breathing. This is a medical emergency, and if untreated can cause severe breathing problems and even death. It can happen in children and adults.
• Damage to internal organs: This happens when less blood gets to an organ- that organ might stop working. It can happen in many organs, like kidneys, liver and lung. When this happens in the brain, it can cause a stroke – 30% of the children with sickle cell disease have at least one stroke. When it happens in the spleen repeatedly, it causes it to stop working, and since the spleen is part of our immune system, this can cause frequent infections which can be life-threatening.
• Anemia: Sickle cells tend to break down and die, so there are less of them. Anemia causes paleness, weakness, difficulty in exercise and might cause a delay in growth and puberty. Since the anemia is chronic, most patients get used to it and don’t have a lot of symptoms.
• Jaundice: This is a yellowish shade of the skin and the white part of the eyes. It’s caused by the breaking down of sickle cells.

This video explains the disease and its symptoms.

How is it discovered?

A blood test can discover if there is an abnormal hemoglobin molecule in the blood. A genetic test can also be done, which tests for the bad gene. A genetic test can also be done during pregnancy, so it can be found if the baby will have the disease.

How is it treated?

The treatment focuses mainly on treating the symptoms and preventing pain crises – things such as treating infections with antibiotics, easing the pain with pain killers, etc. Also, a drug called hydroxyurea can help. It causes the body to create a different type of hemoglobin, which helps.

What happens after treatment?

The treatment isn’t meant to cure the disease but to help with the symptoms. The life expectancy in sickle cell disease is around 50-60 years, and the most common causes of death are organ failure (especially kidney) and infections.

And what about sickle cell trait? This is when only one copy of the gene is defected, and less then a half of the hemoglobin is distorted. They usually live normally without any symptoms, except in rare cases (like on the House episode).

The bottom line – how do I avoid it?

If both parents have the sickle cell trait or the disease itself, it’s important to perform a prenatal test as explained before.

People who have sickle cell disease already can sometimes avoid the pain crises: drink enough water (to avoid dehydration), avoid smoking and high altitudes (which cause a decrease in the level of oxygen in the blood), avoid cold places, and when exercising rest frequently and drink a lot.

Related posts:

1. Mastocytosis – It’s Not A Tumor, But Its Growth in Your Body Can Kill You (As Seen On House MD)
2. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency – When Certain Conditions Can Destroy Blood Cells
3. Behçet’s Disease – Inflammation of Your Blood Vessels, Throughout the Body (As Seen on House MD)

When we go to the doctor, most of the time we expect to leave with a prescription – but what happens when it gets out of control?

Last week, CNN published the story of Alesandra Rain: she just wanted to sleep better at night, but eventually found herself taking 12 different prescription drugs – each of them causing its own side effects and problems. Eventually she stopped taking all the drugs, suffering from difficult withdrawal symptoms. You can also read her story on her website.

(Photo by Felix Mandoux)

The problem of taking too many medications is called Polypharmacy. It’s more common in older people, but can happen to anyone – you start with one medication, then it causes side effects, which lead to more medications and their side effects, and so on … Another problem when taking too many medications is drug interactions – some drugs just don’t work together so well, and this can cause some more side effects. Eventually you might end up with more symptoms than what you originally had.

So what can we do to avoid it?

• Be aware of what you take. Know the names of the medications you take and what they are for.
• Make sure that one doctor knows about everything you take. A lot of times each drug you take was prescribed by another specialist, and none of them is aware of the other specialists or the medications they prescribed. It’s important to update your primary caregiver (for example, your family doctor) about all the medications you take – this way he/she can see if you take drugs that don’t interact well, or take several drugs which do the same thing. It can help your doctors if you bring a list of the medications you take (or simply bring all your pill bottles) to every appointment.
• Ask your doctor questions. Try to understand why each drug is important, and ask if it’s necessary. Ask what the possible side effects of each drug are (so you know when a new symptom is a side effect of a medication and not related to your basic illness). Ask for how long you should take the drugs – some drugs are only for temporary use (like antibiotics), while other are for a long term (like drugs to treat high cholesterol of hypertension).

(Photo by Steve Smith)

• Don’t stop taking prescription drugs without talking to your doctor. Sometimes it’s dangerous to just stop taking a drug, and a gradual withdrawal is needed.
• Consult a pharmacist about Over-The-Counter (OTC) drugs, especially if you take prescription drugs as well.
• Read the Drug label. This is especially important in Over-The-Counter drugs – the label includes information like the uses of the drug, warnings (when you shouldn’t take it), a list of possible side effects, and information about the dosage and storage of the drug. In the federal women’s health website you can find an example of a prescription drug label and an OTC drug label (it’s relevant for men as well).
• Check if your medications interact with each other. You can use an online tool for that – for example Medscape’s Drug interaction Checker.

Follow these steps and you might just save yourself a few extra unneeded pills. Did you ever find yourself taking too many drugs at the same time? Let us know in the comments.

Related posts:

1. From The Forums – Diabetic Foot and Allergy Medications
2. Asthma – What is It and How To Avoid Attacks
3. Osteoporosis – How Your Bones Can Get Thinner With Age And What You Can Do To Avoid It

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)
On episode 23 of season 7 (the season finale, named “Moving On”), Afsoun Hamidi, a performance artist, collapses during filming one of her projects. Later she has pancreatitis, something resembling a tumor in her brain, and a skin rash. Biopsy of the rash reveals that her symptoms are related to a condition called Wegener’s granulomatosis.

Photo by NBCUniversal

Danger level: High

What is it?

Wegener’s Granulomatosis (WG for short) is an inflammation of blood vessels, restricting blood flow to various organs in the body.

Who gets it?

WG is quite rare. In the United States, for example, it’s estimated that about 3 out of every 100,000 people are sick with it. It’s more common in people of Northern European origins, and is less common in black people. It can occur in any age, but is most common in middle age (the average age when it appears is around 40). Men and women are affected equally.

What causes it?

In WG there is an inflammation of blood vessels in the body, meaning it’s a vasculitis (the medical term for inflammation of blood vessels. There are other diseases in this group – such as temporal arteritis and kawasaki, which we covered before).

Our blood vessels generally come in 3 sizes, much like clothing. Small, medium and large. WG is an inflammation of small and medium sized blood vessels.

It happens because the body actually attacks its own blood vessels. The process isn’t completely understood, but probably involves a change in the body’s immune system which triggers the body destroying its own blood vessels.

WG tends to affect mostly 3 systems in the body: The upper airways, the kidney, and the lungs. They are affected since the arteries that supply them with blood are damaged in the disease.

How does it feel?

There are some general symptoms in WG which include loss of appetite, fever, fatigue, and even weight loss.

Usually the first specific symptoms involve the upper airways and can include nosebleeds, nasal congestion, collapse of the bridge of the nose (causing a deformity called saddle nose, seen in this picture), a hole in the nasal septum (which separates our right side of the nose from the left), inflammation of the sinuses (sinusitis), ear infections, difficulty breathing, and coughing (sometimes a bloody cough).

When the disease is in the lungs people may feel shortness of breath (which may be caused by bleeding in the lungs), or cough. When the kidneys are involved, kidney failure can occur, which may be life threatening.

Other organs may be involved, such as the skin (a rash may appear, like the one on House), the joints – which can become inflamed as well, and the nerves (something which can also affect vision – like the patient on House told that had happened to her).

Believe it or not, but there are even more possible symptoms, into which we won’t get here (including, rarely, pancreatitis, which for some reason was a main manifestation on House).

How is it discovered?

The disease resembles many other diseases, making the diagnosis difficult. A blood test checking for a component in the body called ANCA can be used, since it’s elevated in the disease. A physical exam, x-ray, and urine test, among others, can help with the diagnosis. The definitive way is performing a biopsy (taking a piece of an organ to look at under a microscope) on one of the involved organs, which will show something like this:

WG under a microscope. The round area on the left is called a granuloma, which is a mass of immune cells (that’s how the disease got its name). Photo by Nephron.

How is it treated?

Drugs that suppress the immune system (which attacks the body here) are used in WG. This includes steroids and chemotherapy.

What happens after treatment?

With treatment given on time, symptoms may disappear altogether. Still, in about half of patients, the disease may return. Before the disease was understood and the right treatments were given, about half of all patients died within 5 months. Today more than 75% get to live longer.

The bottom line – How do I avoid it?

Unfortunately, there is no known way to prevent WG.

Related posts:

1. Behçet’s Disease – Inflammation of Your Blood Vessels, Throughout the Body (As Seen on House MD)
2. Waldenström’s macroglobulinemia – A Rare Blood Cancer That Can Lead To Strokes
3. Peripheral Arterial Disease – A Narrowing of Blood Vessels that Will Shorten Your Life

This is part of our House MD Project series.

Make sure to tune in tomorrow for a medical recap of tonight’s finale!

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


On episode 22 of season 7, named “After Hours”, a woman named Darrien is bleeding after a stabbing to her body. Her blood pressure and heart rate are almost missing on one side of her body, meaning something is blocking one of the arteries there. She then starts hallucinating due to an interruption of blood flow to her brain. Fever also develops, hinting at an infection. Turns out her symptoms were due to an infection with entamoeba, a parasite, which was released to her bloodstream by the stabbing.

Photo by NBCUniversal

Danger level: Medium

What is it?

Entamoeba histolytica is a parasite which can infect humans. It can infect the large intestine and sometimes the liver and other organs, causing a condition called amebiasis.

Who gets it?

It’s estimated that about 10% of the world’s population are infected with Entamoeba histolytica. It’s more common in some areas of the world where sanitation is poor, such as Central and South America, Africa, and Asia. In the United States it is estimated that about 4% of the population are infected – most of them are immigrants or people who have traveled to countries where it’s more common.

What causes it?

The infection, as mentioned above, is caused by a parasite – an ameba named Entamoeba histolytica, seen under a microscope in this photo:

The parasite can exist in 2 forms: One active (called a trophozoite) and one dormant – called a cyst. Infection occurs when a person swallows cysts. They hatch in the body, releasing trophozoites. These in turn start multiplying and can cause wounds in the lining of the intestines. They can also spread to the liver and other places.

Some trophozoites become cysts again, and are excreted in the feces, helping the infection spread.

Now how do people actually get to swallowing the parasite, or how do they infect themselves? The cysts can spread from person to person or through food or water. In places where there is poor sanitation, food and water can be contaminated with feces containing the ameba. If soil is polluted by human feces, fruits and vegetables growing in it will be infected as well. If someone doesn’t wash hands properly after going to the toilet, the infection can spread. You’re getting the idea…

How does it feel?

In many people (about 80%), the infection isn’t felt at all. When it is felt, symptoms start within about 2-4 weeks of ingesting the parasite, and can include flatulence, abdominal pain, diarrhea, or constipation. In some cases a dysentery may be caused, meaning there is blood and mucus in the feces. Fever may also develop. Blockage as well as perforation of the intestines can occur.

Sometimes the ameba may spread to the liver, causing an abscess (a localized collection of pus). The person would feel fever and chills, sweating, nausea and vomiting, and weight loss. Rarely, the ameba can spread to other areas of the body (even the brain).

This vivid video sums it up:

How is it discovered?

A stool sample has to be examined to find the ameba. Sometimes a tube with a camera (colonoscope) can be inserted to the colon to collect a sample from a wound caused by the ameba, to look at under a microscope.

To find a liver abscess, an imaging method such as an ultrasound, CT or MRI can be used. Blood tests can also help with the discovery of the parasite.

How is it treated?

An antibiotic is given that can kill the ameba. An example of such a drug is metronidazole (which was mentioned on House).

The bottom line – How do I avoid it?

When travelling to an area known to have poor sanitary conditions, make sure to drink only bottled water, tap water that’s been boiled for at least 1 minute, or bubbly water or soda drinks from sealed cans.

Do not drink fountain drinks or any drinks with ice cubes. Do not eat fresh fruit or vegetables you didn’t peel yourself. Do not eat dairy products that may not have been pasteurized. And don’t eat anything sold by street vendors.

If you have been infected, you can minimize risk of infection to others by washing your hands with soap and water after using the toilet, after changing diapers, and before handling food.

Related posts:

1. Malaria – A Deadly Infection Passed On By Mosquitoes (As Seen on House MD)
2. Gas Gangrene – An Infection That Can Rapidly Kill Your Muscles (As Seen on House MD)
3. Common Variable Immunodeficiency (CVID)–When a Cold Can Threaten Your Life (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!)


This episode (episode 21 of season 7, named “The Fix”) is a little tricky, since there were two major diseases here. First, Wendy Lee, a weapons designer, has a seizure, abdominal pain, inflammation around the kidney, a heart attack, rectal and vaginal bleeding, burning and bleeding gums and swollen genitals. She was poisoned with Spanish Fly (containing cantharidin, a toxin). The other story involved a boxer who passed out way too early during a fight. House discovers he has a glomus tumor in the back of his neck, which when pressed during the fight caused him to collapse.
We’ll be more brief about each condition here, since there are two of them.

Photo by FOX

Spanish Fly

It all starts with a green beetle called the Spanish Fly, pictured below.

Photo by Franco Christophe

The beetle contains a material called cantharidin. The beetle is usually crushed into powder form, which has many uses. One of them is getting farm animals to mate.

Throughout history, it’s also been used as a means of keeping an erection. This happens since, when it’s excreted in the urine, it causes swelling of the genitals (like was seen on House), and also an erection.

Another use is as an aphrodisiac (a substance that increases sexual desire).

Unfortunately, if the concentration of catharidin isn’t low enough, more than sexual arousal can occur – it can lead to actual poisoning.

How does it feel?

Catharidin poisoning can lead to burning of the mouth, pain while swallowing, nausea, vomiting blood, urinating blood, and painful urination. It can lead to bleeding of the upper gastrointestinal tract and its erosion. It can damage the kidneys. It can also, as was seen on House, lead to seizures and to problems with the heart. And last but not least, it can lead to an uncontrollable erection.

How is it treated?

There is no antidote. The only way to treat someone poisoned with Spanish Fly is through supportive treatment, which means treating the various symptoms.

Glomus Tumor

These are rare tumors belonging to a group of tumors called paragangliomas. Those of you with good memories will recall that we’ve also featured an article about a disease called pheochromocytoma, which usually occurs in the adrenal gland. When it occurs outside the gland, it’s called a paraganglioma.

When paragangliomas occur in the area of the base of the skull they are called glomus tumors.

And how does this all come together?

Pheochromocytomas, and paragangliomas, are tumors that secrete substances called catecholamines (such as epinephrine). When these are secreted, they can lead to hypertension, headaches, palpitations, sweating, nervousness, and even weight loss (the boxer on the House episode was so overworked when his tumor was pressed and released these substances, that he has lost consciousness).

Photo by mitopencourseware

How is it discovered?

The tumor can be discovered by taking a urine sample for catecholamines, which will be higher than normal. A CT, MRI, or other form of imaging technique can discover where in the body the tumor is located.

How is it treated?

The tumor is usually taken out in surgery, although in some cases radiation therapy is used.

Related posts:

1. Sleeping Sickness – A Fly Bite That Ends in A Coma (As Seen on House MD)
2. Carcinoid Tumors – A Rare Tumor Often Not Found On Time
3. Nesidioblastoma – A Tumor of the Pancreas That Can Secrete Hormones (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 17 of season 7, called “Fall From Grace”, a homeless man arrives at the hospital with dysosmia (an altered sense of smell). After that he has bleeding in his GI tract, “tunnel vision” (meaning he can’t see his peripheries, only what’s directly in front of him), and cerebellar ataxia (meaning a problem with his coordination). It’s found that the healthy food he has been eating in the hospital caused this since he has Refsum disease.

Photo by FOX

Danger level: Medium

What is it?

Refsum disease is an inherited condition causing mainly vision loss and a change in the sense of smell, as well as other things.

Who gets it?

It’s thought to be uncommon, with no one knowing how really widespread it is. It is known that in the UK and Europe it occurs in about 1 out of every 1,000,000 people, but it is probably more common than that.

The condition is inherited in families. Both parents have to carry a defective gene and transfer it to the child in order for the disease to be transferred to them.

What causes it?

The disease is caused by a defect in the genes, causing a buildup of a material called phytanic acid. You get this material from your diet, especially from beef and dairy products. This material is usually broken down by the body. In Refsum disease, this process doesn’t work properly, causing it to not break down and instead accumulate in the body. Since this material is toxic to our cells, it causes the disruption in sight and smell, as well as other symptoms.

How does it feel?

There are several things which occur in this disease:

• 1. Vision loss: It starts with loss of night vision, and later affects peripheral vision, making you see only what’s in front of you (a situation called “tunnel vision”).
  2. Anosmia (loss of the sense of smell) or dysosmia (smelling things differently than how they really smell).
  3. Problems with the bones in the hands and feet – This happens to about one third of patients.
  4. Muscle weakness and wasting
  5. Poor balance and coordination – This is called ataxia, and was shown on the House episode.
  6. Hearing loss
  7. Dry, scaly skin (called ichthyosis)
  8. Some develop an abnormal heart rhythm (arrhythmia) and other heart problems that can be life-threatening.

How is it discovered?

The disease is suspected in people showing up all or part of the symptoms above. In these people, a test is done which measures the blood level of phytanic acid. In people with the disease it will usually be exceptionally high.

A test of DNA can also be made, which finds the defective gene associated with this disease.

There are other tests as well, but they are beyond the scope of this article.

How is it treated?

There is no direct treatment. People with Refsum disease are advised to avoid foods that contain phytanic acid. These foods include dairy products; beef and lamb; and fatty fish such as tuna, cod, and haddock.

Some people will also have to undergo plasmapharesis, a procedure in which their blood is drawn and filtered and then returned to the body. This is done in order to lower the level of phytanic acid in the blood.

What happens after treatment?

Some symptoms, such as muscle weakness and the skin problem, disappear with treatment. Others, unfortunately, don’t. This includes the vision, smelling and hearing problems, that may persist.

The disease, if untreated, can also lead to death due to problems with the heart rhythm.

The bottom line – How do I avoid it?

Since the condition is genetic, there is really no way to avoid it. You can, however, avoid the symptoms if you restrict phytanic acid containing foods in your diet, once you discover that you have the disease.

Related posts:

1. Diverticulitis – Or Why A Diet Rich in Fiber is Important For You
2. Why Staying Up Late Isn’t Good for Your Diet

Fibromyalgia is a chronic syndrome characterized by muscle and joint pain, stiffness and fatigue. About 3.4% of US women experience the disease (as you can read in our full article – Fibromyalgia – Chronic pain and fatigue). One such woman is Julie Wendell, and she chose to share her story with us.

Have a story of your own to share? Feel free to contact us anytime

“Mommy, open this, please?”, my 3 year old son asked as he handed me a cereal bar early one morning. I tried to tear off the top of the wrapper, but my fingers would not move or grasp the wrapper! Terrified, I tried opening it again, but to no avail. I had lost all strength in both of my hands! As calmly as I could, I asked my 7 year old son to open the cereal bar for his brother. But inside, I was panicking because the weakness in my hands persisted for about an hour. What was happening to me??? Little did I know that the morning of February 10th, 2008 marked the beginning of a myriad of severely painful symptoms. My life was about to drastically change.

Over the course of the next few weeks, I started to experience alarming new symptoms. In addition to the weakness in my hands, I noticed that the joints in my hands were very swollen and stiff. I even took pictures of my hands from all angles to make sure that their odd shape was not just my imagination. I would often feel sharp zinging pains in my extremities, especially in my hands, wrists, knees, and ankles. My muscles and joints ached like I had the flu. There were times when I would be convinced I had a temperature of at least 101, just to find out it was completely normal every time I checked.

My level of fatigue went from “full time single working mother” to “full time single working mother who also ran 100 miles a day”. I was physically exhausted from dealing with so much pain every day. To make matters worse, I started noticing that when I woke up each morning, I would not feel refreshed, even after a full straight 6-8 hours of sleep. Instead, it felt like I only slept for one hour each night. So not only was I physically exhausted, I was emotionally drained as well. The overall level of exhaustion was indescribable, the worst I have ever experienced in my life! But I was hoping that whatever was plaguing me would just stop on its own.

One afternoon in April 2008, after I got off work and picked up my kids, I couldn’t get home fast enough. My body was overwhelmed with pain like I never felt before. As soon as we walked through the door, I immediately headed for the couch, where I spent the next four days. I had to call my mom to help me take care of the kids. In addition to my existing symptoms, I also suffered from oppressive chest pain, muscles/joints that felt bruised, extreme coldness in my arms and face, and TMJ-like jaw pain. I also had the sensation that my aching spine and pelvis were going to slide out of my body. I cried often, because I had no idea how to cope with these bizarre symptoms. I tried heating packs, ice packs, Tylenol/Advil, but nothing even remotely helped me. My temperature was still normal at 98.6. My mom, who is a nurse, thought maybe I had a virus, but most of the symptoms did not even resemble any virus I had ever had in the past, plus I was not running a fever. Even after the four worst days of feeling severely “sick”, most of my symptoms never fully disappeared.

At this point, I was at my wits’ end, so I finally decided to get some help. So even though I was terrified of the possible outcomes, I made an appointment to see my primary care physician. After reviewing my list of symptoms and seeing the pictures of my hands, he thought it was very likely that I had rheumatoid arthritis. He immediately referred me to a rheumatologist, who wanted to test me for not only rheumatoid arthritis, but also lupus, mononucleosis, and multiple sclerosis. He ordered some x-rays of my hands and a lot of blood work. He also prescribed a week’s worth of steroids to see if that would help.

My daily life started becoming a real chore for me. Everything and anything I usually did without a problem was now unbearable or overwhelming. The mornings and evenings were the worst times of day for my pain, fatigue, and weakness. I tried to stay strong, especially for my children, but there were days where I felt like giving up on everything. I tried talking to a few friends and family members about how I was feeling, but they would just say that I was complaining too much and/or accuse me of being a hypochondriac. I had never felt so alone in my life.

The results of the blood tests and x-rays came back the following week and were completely normal. Also, the steroids ended up not helping me at all. Based on these findings, the rheumatologist suggested that I may have fibromyalgia. He prescribed an NSAID called Mobic to help with my muscle/joint pain and an anti-convulsant/anti-neuropathy medication called gabapentin to help with my nerve pain. The doctor said that diagnosing fibromyalgia was very tricky because there are no actual diagnostic tools. Instead, the diagnosis is made after everything else has been ruled out. He also wanted to wait and see how the next few months went with the new medications before confirming the suspected diagnosis.

During the following months, both of the medications had made a difference to where my daily activities became more tolerable. I still felt very fatigued, but my quality of sleep seemed to be more restorative (due to the gabapentin). My muscle and joint pain were definitely persistent but they were on more manageable levels (due to the Mobic).

When I went back to the doctor in August 2008, he reviewed all of my test results and evaluated me again, then officially diagnosed me with fibromyalgia, a syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints. The treatment for fibromyalgia includes pain medication and exercise. The doctor advised me to continue with the medications I was currently taking and to try doing light exercise when possible. He also warned me that my medication combination was not always going to be perfect. He said it may take a few tries with various medications before reaching optimal pain management, and what works for me now may not work for me in a few years. I was completely devastated, knowing that I was going to live with unrelenting complicated pain and severe fatigue for the rest of my life.

Sometimes, in addition to medication and exercise, doctors recommend a gluten free diet to help alleviate fibromyalgia symptoms. Coincidentally, I had already been on a gluten free diet for 4 years already, due to having an auto-immune digestive disorder called Celiac Disease. Unfortunately, being on this diet did not stop me from having fibromyalgia nor had it eased its symptoms. My doctor said that I’m one of the unlucky fibromyalgia patients who was not positively affected by a gluten free diet. Sometimes I like to think that being gluten free has stopped my fibromyalgia symptoms from becoming uncontrollable.

A diagnosis of fibromyalgia carries a negative stigma in society because the symptoms are very vague and are not so clear-cut as other diseases/conditions. I have actually heard people say that there is no such thing as fibromyalgia, or that the symptoms are fake and they are all in the person’s head. It is also widely believed that people who have fibromyalgia just want attention and/or medication. There are many doctors do not recognize fibromyalgia as an actual medical condition. Therefore, people who do have fibromyalgia usually have to see numerous doctors before receiving a diagnosis. Luckily for me, reaching a diagnosis for my symptoms only took 6 months and involved seeing only 2 doctors. Some people suffer for years before finding an answer.

Since my diagnosis, additional symptoms have added themselves onto the original list, such as hypersensitivity to stimuli. For example, if there is too much light or sound, I start feeling very overwhelmed and need to remove myself from the situation. There are times where I cannot be touched, when even my clothes feel like too much overload on my skin and receiving a hug actually HURTS. I also started becoming sensitive to the weather patterns, especially low pressure systems. I jokingly call myself the “human barometer” because I seem to predict rain better than the weatherman! During periods of damp or cold weather, my muscles and joints heavily protest, and in turn, the pain increases substantially. I found that I have a low tolerance for any kind of exercise, it makes me feel worse rather than making me feel energetic and refreshed. I have also developed difficulty with my short term memory and concentration (i.e.-”fibro-fog”), which has affected all aspects of my life, especially work.

Today, it remains difficult for me to deal with the pain and fatigue that I experience every day with fibromyalgia. My doctor has changed my pain reliever from Mobic to tramadol, which is a bit stronger, so my pain is at a tolerable level most of the time. But I definitely have my share of bad days. On a positive note, I have learned a few things from my experience with fibromyalgia. I’ve learned not push myself to do more than I can handle, but I’m still learning that it’s okay to ask for help. I have also learned to prioritize what is actually important and to just take things one day at a time. Having fibromyalgia has made me realize it is so important not to take anything for granted. After my diagnosis, my rheumatologist had pointed out to me that fibromyalgia is not a deadly or destructive disease, which is very fortunate. However, living with chronic pain and fatigue is still a difficult challenge, no matter what the cause or prognosis. Yes, fibromyalgia is REAL.

Related posts:

1. Fibromyalgia – Chronic Pain and Fatigue
2. Tension Headache – The Toll We Pay for a Stressful Living

This is a guest post by Ashley Warner. Ashley is a graduate student working toward her Masters in Conservation Biology. She currently resides in Washington state and is a part-time content creator for Online Biology Degree.

Danger level: High

What is it?

Chagas disease (also called “American trypanosomiasis”) is an infection that eventually causes potentially fatal heart and digestive problems in 20-40 percent of infected humans.

Who gets it?

The parasite responsible for the disease, Trypanosoma cruzi (T. cruzi), exists mostly in central and south America and in Mexico, although a small number of infections documented in the southern United States indicate that the disease has spread into the north. Similarly, recent population movements have led to cases as far afield as Europe. Anyone living in one of these regions, particularly in a rural area, could potentially become infected.

What causes it?

T. cruzi lives in wild mammals such as opossums, armadillos, rats and raccoons and may inhabit domestic animals as well. The disease is transmitted to humans by triatomines (also called reduviid bugs), insects that feed on the blood of vertebrate animals. Often biting the faces of human victims, triatomines are commonly called “kissing bugs.”

A kissing bug. Photo by Fernando Otálora Luna

These insects defecate while feeding, and if one is carrying T. cruzi from a previous meal, the parasites will be in the feces. When human victims scratch at the bite, the infected feces enter the blood through the bite wound itself. The parasites can also pass through other places, such as the eye.

T. cruzi can also be transmitted by consumption of contaminated food (including breast milk), through transfusion of infected blood or transplantation of infected organs, and from an infected mother to her unborn child.

How does it feel?

Chagas disease proceeds in two phases.

The initial, acute phase, lasts for weeks or months. It usually brings about mild symptoms, if any, beyond swelling at the site of infection. The most recognizable symptom of acute infection, called Romaña’s sign, is swelling around the eye where the parasites reside.

A child with a Romana’s sign.

After several weeks, the infection proceeds to the chronic phase. In most cases, the parasites’ presence will cause no symptoms. This is known as indeterminate chronic Chagas disease. However, when symptoms do develop, they severely affect the heart and digestive system.

Cardiomyopathy (damage to the heart muscle) can lead to sudden death, while megacolon and megaesophagus (dilation and enlargement of the intestines and throat) cause difficulty swallowing, loss of weight and malnutrition and other life-threatening complications. In some cases chronic Chagas disease also affects the nervous system, impairing reflexes and sense perception.

How is it discovered?

Because it often presents no distinct symptoms (or no symptoms at all), Chagas disease can be difficult to detect. Diagnosis depend on detecting T. cruzi in the blood or the presence of antibodies specific to the parasite (antibodies are molecules the body produces to fight an infection).

How is it treated?

Acute cases respond well to antiparasitic drugs, and are often completely curable. In general, the younger the patient and the sooner treatment is received, the better the odds that the parasites can be eliminated.

However, in its chronic phase, Chagas disease becomes more and more incurable. In determinate chronic cases (where symptoms do appear), currently available antiparasitic treatments are not effective.

What happens after treatment?

If the disease is effectively treated with antiparasitic drugs, the parasite infection has been completely cured and the patient should suffer no further ill effects. Damage to the body in chronic cases may be irreversible even if a the parasites have been eliminated.

The bottom line — How do I avoid it?

Although research to develop one is underway, there is no vaccine for Chagas disease. The surest way to avoid infection is to avoid travel in regions where the disease is common. If you do spend any time in areas known to harbor T. cruzi and the kissing bugs that transmit it, avoid sleeping outdoors or in rural areas where the insects may inhabit buildings. Sleeping under a mosquito net is also advisable.

Related posts:

1. Leprosy – The Biblical Disease is Still With Us (As Seen On House MD)
2. Malaria – A Deadly Infection Passed On By Mosquitoes (As Seen on House MD)
3. Syphilis – The 4 Stage Disease That Will Make You Want To Wear A Condom