House Watch: When Luck Takes Over

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House M.D. is usually obsessed with lying, but last night it reached for a lesson in luck. What happens if you win the lottery but also develop three different types of cancer at once?

Some answers and all the diagnoses in a second, but first a spoiler alert: if you haven’t seen the episode, “Changes,” shove a corpse from its bed and lay down to watch last night’s House M.D. before reading on.

Patient this week is Cyrus, a porky lottery winner obsessed with a girl he once knew. (I suppose it would be churlish here to mention the similarities to a certain Lost character.) Cyrus collapses in the opening scene and says his leg won’t move.

House opens the first DDX meeting by saying a head CT and a lumbar puncture showed nothing, and that an MRI of his spine was clean. It’s a brain problem, House says, but it appears there’s nothing wrong with the guy’s brain.

Before he won the lottery, Cyrus repaired appliances, so Foreman’s first thought is toxic brain damage from working with chemicals over the years.

But Taub focuses on Cyrus’ money and how it might have changed him. (In fact, Taub seems downright jealous of all that money, which — once again — totally puzzles me: Why is Taub the only member of the team always worried about money? Is there a story line brewing here, or is it just that the writers are trading in Jewish stereotypes? True, Taub is recently divorced, and there’s probably alimony, etc., but is his salary that low?)

Anyway, Taub’s theory is that the newly-rich Cyrus might have started to collect ceramics or precious metals, which could have given him atherosclerosis on his carotid arteries. Atherosclerosis is essentially hardening of the arteries, although the mechanism by which ceramics and precious metals would lead to it isn’t quite explained.

Maybe that’s why House picks Foreman’s theory: he orders the team to search the patient’s old workshop for evidence of toxic brain damage.

There were two side plots last night, neither especially riveting. First, Candice Bergen is back as Cuddy’s mom. She threatens to sue the hospital for the various lapses in ethics that led to her hip replacement. But it turns out she just wants House and Cuddy to see her as a common enemy so they get back together. Her reasoning seems solid: she says, accurately, that Cuddy and House are both emotional idiots, so they deserve each other. But Bergen didn’t have much else to do in this episode, so it was a bit curious she came back for it.

The other side plot is also weak. Chase and Foreman become embroiled in a rivalry over which one can successfully control his urges. Chase, the lustful playboy, is trying to be celibate. Foreman, the repressed contrarian, is trying to be more agreeable — to the point that he submits to several blood-pressure tests during DDX meetings to see if he can keep his temper down.

Eventually, neither of them departs from his ways, which was about as surprising as bad hospital food. But this side plot did provide the funniest House line of the night: when Foreman asks House why House is badgering him about his tightly coiled personality but not Chase about his horniness, House answers: “Because, I can get a rise out of your BP. His pee-pee, on the other hand…”

Meantime, Patient says he doesn’t take drugs but that he does eat most of his food from cans. (He says it was a cheap way to eat when he was a repairman, and he got used to it.) Chase also finds that Cyrus was using an off-brand Chinese solvent in his workshop, so he might have inhaled some toxic volatile substance.

But a new symptom presents itself: when Cyrus vomits, 13 says he’s having a partial seizure. At the next DDX meeting, Foreman suggests Patient has Lyme disease — but a test already ruled it out. Taub thinks postural hypotension, which is a strange diagnosis since postural hypotension is a temporary drop in blood pressure due to standing up too quickly. 13 offers herpes encephalitis, a rare inflammation of the brain due to the herpes virus.

During tests, the team finds a solid mass on Cyrus’ pancreas. Wilson is pretty sure it’s cancer. He says paraneoplastic syndrome — a rare cancer complication caused when cancer-fighting cells attack nerve cells — would explain the neurological symptoms.

But an MRI finds two more tumors of completely different types, one on a kidney and one in his colon. At the next DDX, 13 says he might have a genetic disorder that eliminated one of his tumor-suppressing genes.

To find it, House decides to pump Patient full of vascular endothelial growth factor, which will stimulate the cancers to grow even bigger. But in fact the cancers shrink. 13 thinks he has amyloidosis, a buildup of proteins in the organs. The masses aren’t cancers, she thinks, but protein deposits.

Before she can confirm, Patient has a heart attack, and his liver fails. Just in time, as usual, House figures out the final diagnosis: Cyrus has a teratoma, a tumor that can be composed of multiple cell types. The teratoma is producing primitive cells, which can grow quickly and produce cancers. (Again, the mechanism here is almost entirely unexplained, which is rare for this particular medical drama.)

The show winds up with the lottery winner finding out he will almost certainly live — the teratoma can be cut out, along with the remnants of his tumors. Also, his long-lost love appears at the end, meaning his lucky streak continues. This rattles 13, whose mother is dead and whose brother she euthanized — and who, as House points out, has “the life expectancy of a pretty good sitcom.” 13 has no luck, and Cyrus has all the luck in the world. The whole thing makes no sense: “Lotteries are stupid,” she says.

Overall, it was a middling episode (my final diagnosis: C+).

What is interesting to me as we hurtle toward the season finale is how the show will handle House’s full-throttle relapse into Vicodin addiction. Last night he was popping those white pills like M&Ms again (and we learned that Wilson is the one approving the prescriptions). But when will House return to rehab, if ever?

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Follow my health columns on Twitter @JohnAshleyCloud

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