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Nepene t1_ivkrosz wrote

He was looking for a birth control scar from an implant. He presumably guessed she was pregnant from her appearance, confirming it with an ultrasound. He was ambiguous because he likes having an air of mystery to his patient examinations.

So, the relationship is that in your arm medical professionals often implant a small plastic tube called a Nexplanon or Implanon containing etonogestrel which blocks pregnancy normally, and failed in her case.

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RainingRabbits t1_ivlekt2 wrote

Replying to Nepene (#475,428)

To add on to this - these implants are typically close to the skin and can often be seen when thin people raise their arms. If it's implanted deeper or the person is larger, you can tell if someone has one by looking for a small round scar.

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Matthew_C1314 t1_ivmj0bk wrote

Replying to Nepene (#475,428)

This happens in a few episodes, but is this not the one where she raises her arms and he determines that the clothes are smaller on her since she gained weight. Like lifting the arm lifted the shirt?

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mcnabcam t1_ivmydyv wrote

Replying to [deleted] (#478,519)

The idea being that someone on implanted birth control is more likely to be sexually active and less likely to have a secondary birth control method like condoms. She would presumably have noticed a condom failing and would not be as oblivious to her pregnancy

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killcat t1_ivn9os6 wrote

House was often.....questionable, cases where basic tests would have diagnosed the issues within a couple of days, such as a case of amoebic meningitis, with an altered mental state, so a lumbar puncture would have been one of the 1st things they did, and a lab would have spotted it.

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BioEdge t1_ivncark wrote

Replying to [deleted] (#480,170)

I'm a paramedic and my skin is crawling just thinking about it. I can take seeing inside a skull, but things embedded under skin is where I lose it

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EmilyU1F984 t1_ivnp8iz wrote

Replying to mcnabcam (#480,154)

It‘s insane to me that people on continuous Bc are not recommended to do monthly pregnancy tests. Those tests are less than 50 cents when bought in bulk.

And you will most likely miss the pregnancy on an implant or IUD far past legal limits for abortion.

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EmilyU1F984 t1_ivny2ds wrote

Replying to finishedlurking (#481,833)

Nah it‘s not recommended in the first place. That‘s the major problem.

Otherwise: 50 cents a month is cheaper than the eventual late term abortion or full term pregnancy.

The problem is people not being given adequate information to make informed healthcare choices. Not poverty itself. In this case specifically.

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spacemanv t1_ivnzdhm wrote

Replying to Watsonmolly (#481,855)

The first rash is actually immediately over the bite in 70% of cases, and is a immune mediated superficial skin rash. It actually gets it's characteristic bullseye shape from the center being an immune reaction to the salivary proteins, and the outer ring being the spread of bacteria outwards in the skin. You see them behind the knees because it's easy for ticks to get brushed into skin folds.

The secondary (stage 2) lesions and lymphadenopathy happen after the bacteria spreads from the initial lesion in the weeks following.

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Ensia t1_ivnzfqc wrote

Replying to killcat (#480,745)

And full of misinformation on top of that. I remember a few episodes in they said malaria is caused by a fungi and that was it for me. You don't even need to pay an expert for that, Wikipedia would have told you it's a parasite. Maybe I'm being nitpicky, but stuff like that really rubs me the wrong way.

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weeknie t1_ivnzq89 wrote

Replying to Ensia (#481,897)

I know they often embellished the symptoms or the chance of something happening, but this is such a basic fact that it's just ridiculous. Then again, you feel like you're being nitpicky, which makes you feel me doubt whether they actually said it as straightforwardly as your suggesting

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Ensia t1_ivo022n wrote

Replying to weeknie (#481,907)

Granted it was a long time ago, but i remember the scene was at the end of the episode where they figured everything out and were telling the patient they have malaria, which is a disease caused by a fungi and now they just need to take some medicine and it'll all be alright.

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EmilyU1F984 t1_ivo0t6p wrote

Replying to [deleted] (#481,860)

Mate I’m saying that‘s how it is, because it’s not standard practice. Individual physicians going above and beyond official guidelines is commendable but not standard practice.

Just like painkillers and anesthesia isn‘t standard.

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ijustwannacomments t1_ivo0vf7 wrote

Replying to Ensia (#481,897)

Pretty sure I remember an article that linked the popularity of Scrubs to an increase in medical mistakes be because basically "lol woops oh well everyone makes mistakes 😅"

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oscillius t1_ivo48vz wrote

Replying to Ensia (#481,897)

I really enjoyed house. Love Hugh Laurie as an actor. I’ve watched the shows more times than I can count although it’s been a long time I think I know the episode you’re talking about.

But im pretty sure it was toxoplasmosis they said was caused by a fungus and not malaria.

The only malaria episode I remember is where the guy can’t speak properly, a journalist with bipolar or something. They diagnose malaria at the end but I don’t remember them mentioning fungus.

I checked for that episode and it was s2e10 “failure to communicate”, diagnosis was cerebral malaria. Some websites listed the goofs and they say that when they looked into the slides the “parasite” that was supposed to be malaria looked more like the bacteria that causes syphilis.

I’m trying to find the episode with toxoplasmosis but I can’t remember what the episode was called. I remember it was about a politician. I’ll edit it when I find it.

E: https://www.moviemistakes.com/tv4941/episode23818

Didn’t take long, s1e17, “role model”. It wasn’t the final diagnosis so I couldn’t find it in the list. But that website has the mistake listed at the top.

“Factual error: House and Foreman tell the Senator that he has toxoplasmosis, which is caused by a fungus. Toxoplasmosis is actually caused by a protozoan parasite”

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BoOtto t1_ivo5rug wrote

Replying to killcat (#480,745)

I was in med school when it first aired and one of the first cases I remember was a child with neurological symptoms and obesity. They had run all kinds of tests already and I was wondering which disease could be so similar to Cushing’s… it was Cushing’s syndrome, which would be one of the first things to test for.

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heteromer t1_ivo6h54 wrote

Replying to DJHellduck (#482,103)

Because the implants aren't in your skin. They're subcutaneous, which lies underneath the dermal layers. People who are overweight have greater subcutaneous fat content, so it might not be as visible.

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DeltaBlack t1_ivo8lis wrote

Replying to BoOtto (#482,201)

There was a website named Polite Dissent from an MD who reviewed the episodes. Unfortunately it no longer exists but I remember that especially in the later episodes some issues would have been diagnosed very quickly with standard medical procedures.

I think in one instance it was said that looking at the blood sample before running the lab tests would have revealed the disease instantly. In another it was said that after a positive pregnancy test and a negative ultrasound test the next step was to look for an ectopic pregnancy (which took the team a while to figure out).

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gargling_ t1_ivoc690 wrote

Replying to BoOtto (#482,201)

I remember that episode; to be fair, they tested for Cushing's a couple of times throughout the episode. The tests were just coming negative (until they finally sent an early morning sample). I think that episode was more so to highlight the fact that tests should not be the Hail Mary while looking for a diagnosis

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BrowsOfSteel t1_ivod6jw wrote

Replying to killcat (#480,745)

Yeah and there are a bunch of episodes where the team has their hands tied for contrived reasons.

This can be because the writers are cribbing from a case report, and the case is old enough that it predates nMRI or whatever.

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snpods t1_ivoem03 wrote

Replying to EmilyU1F984 (#481,425)

The counter-argument to that is that an implant like Nexplanon is highly effective. More effective than condoms or the pill based on actual usage by a decent margin.

1 in 1,000 people using Nexplanon over three years will become pregnant. There’s no such thing as user error once the device has been in place for several weeks.

For condoms, the practical efficacy rate is about 87% per year. For the pill, it’s about 93%.

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ArbitraryBaker t1_ivoirua wrote

Replying to EmilyU1F984 (#481,425)

Fewer than eight out of 1,000 women (0.8 percent) become pregnant over five years using Mirena. Why should I do more pregnancy tests than someone who uses condoms? My daily activities wouldn’t change much based on whether I got a pregnancy diagnosis or not.

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Morael t1_ivojdn7 wrote

One thing I'd like to address here is that this question inherently implies that House MD is somehow representative of real medicine. This is a topic I've had to breach with hundreds of students over the past 10 years when I was still teaching chemistry...

House is about as far from real medicine as you can get. The number of times his medical license would have been revoked is very high. He uses questionable methods and skips over very basic diagnostics on a predictably regular scale. The show puts that in the light of him being outspoken and clever, but in real life that would just be bullheaded stupidity.

Don't expect there will always be a "real" explanation for what he's doing, because there often isn't. Some comments here have brought up subdermal birth control for the scene in question, and maybe that was the intent... But there's a dozen other ways that diagnosis could have been confirmed that are much more scientifically sound.

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Voctus t1_ivol4a8 wrote

Replying to ArbitraryBaker (#482,990)

Presumably someone using only condoms would have a missed period as a hint that they need to take a test, while many women on continuous birth control have infrequent or no periods so wouldn’t otherwise notice something was different.

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lucidrevolution t1_ivonslc wrote

Not very poignant given that the OP had a specific question that was answered by others... but I have some books sitting in my Kindle queue written by the consulting internist who helped them break down a lot of the medical cases in the show (Lisa Sanders, MD)... I first got into trying to find the "real" cases they reference from being into Grey's for years, and realizing some stuff I read popped up in the storylines when they need a weird rare disease.

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EmilyU1F984 t1_ivopyzh wrote

Replying to snpods (#482,741)

It‘s 6 USD per year to test monthly, a non medical abortion runs you at least 300USD, having to birth the child risks you half a million or death and permanent disfigurement plus the psychological trauma of being forced to carry a baby to term.

Seems like with the 1 in 1000 rate per 3 years, it’s advisable to just test.

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snpods t1_ivovmoj wrote

Replying to [deleted] (#478,519)

Based on your username, I’m guessing you’re a gynecologist? If so … is it also true that the manufacturer improved the insertion device when transitioning from Implanon to Nexplanon?

My doc was mentioning something during the insertion procedure for my first Nexplanon (after I had already had Implanon), but I get squeamish and wasn’t paying attention. Lol. I’ve been curious for years, but never asked again!

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Kile147 t1_ivpb5hq wrote

Replying to Morael (#483,033)

Yes, but do those other methods of diagnosis allow House to look like a magician who pulls diagnoses from thin air?

Both in universe and for the show it makes sense for House to go with the most dramatic option because a large part of his personality is wanting people to see him as a genius.

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Nemisis_the_2nd t1_iw0crx0 wrote

Replying to killcat (#480,745)

> would have diagnosed the issues within a couple of days, such as a case of amoebic meningitis

If a patient at my hospital had any form of meningitis suspected, and didn't have lumbar puncture results with the doctor in less that 6 hours, heads would be rolling (no pun intended) I remember one case where the patient had to wait over 8 hours for the results (not my labs fault) and multiple people ended up facing disciplinares. Meningitis can kill, fast. Taking your time to diagnose it will result in needless patient deaths.

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Ruca705 t1_iw2c2qp wrote

Replying to EmilyU1F984 (#481,854)

Have you considered the huge amount of plastic production and chemical waste that would take place if every user of a Bc implant started testing monthly? We are talking a very large amount of pregnancy tests here. Millions upon millions of people around the world have these implants, you want to multiply that by 36 for the duration of the implant, can’t you see how astronomically wasteful and damaging to the planet that would be?

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