Our first guest post of the blog. Matthew Higgins is doing a PhD in the same building as James and I, after going through undergrad and honours with us. He works on a particular protein involved in breast cancer that may be souped-up to make super cancer or something: it’s immunology, what do I care? He also often comments around these pages under the guise of “lumpage” (Yes, now I’ve revealed your secret identity!). He lives on The Ranch Dressing. Maybe you should read that.
I love House, the T.V show. It’s great. A fine example of scientific reasoning and deduction condensed in to an improbably short 42 minutes. Oh sure, never in the history of mankind has a medical team been so capable that are so diversely and broadly skilled that they can single-handedly perform every medical and scientific test themselves. But don’t let that stop you from enjoying the show. At the end of the day the cast is just as attractive and amiable, and the patient who just seems to go from moral dilemma to medical dilemma repeatedly generally lives. We all go home happy right?
Wrong. Here’s why: It’s never lupus. What kind of a plot hole is that! Statistically,* after 7 years, it should be lupus by now (there was that one time where they thought it was, and treated for it, but it wasn’t… I don’t count that one.)
So because lupus is so overdue, and every good TV show demands an even better drinking game. Here’s some information to better prepare you to make the call on whether it is or isn’t lupus.
What is Lupus? Lupus erythematosus is an autoimmune disease, leading to chronic inflammation. Like any good autoimmune disease, the immune system mistakenly goes into overdrive against your own body. The only problem is, lupus can do the rounds of your body all at once, leaving you feeling deathly ill. Think of the last time you got stung by a bee, pretty shortly afterward you would have experienced the ‘five signs of inflammation’, which characteristically involve redness (due to extra blow flow), swelling (as your vascular system becomes a bit more leaky to allow your immune cells to get out of the blood and go to town on that Bee poison) and heat (all that extra blood flow does tend to get you a bit hot and bothered.) Except this time you are your own poison.
In the real world 90% of lupus cases occur in women, but this is TV. Consequently, The House Drinking Game will see you emptying your glasses every time a patient has a fever, fatigue, rashes, swelling of the joints, anemia, seizures and or difficulty breathing. Here’s the kicker though, you’ll need to listen closesly to find out if the patient is ANA positive or not. ANA (anti-nuclear antibody) are antibodies directed against antigens in the nucleus of human cells. Normal healthy people generally don’t have these. Although this isn’t a conclusive indicator of Lupus, it is certainly worth switching to spirits at this point. In general, having several of these things, plus some others not mentioned here, add up to a diagnosis.
What’s that I hear you say? You’ll be drunk every episode? Apart from this being the ultimate time to be marking student assignments, you should now be able to understand why lupus can be suggested for almost every patient in House – and probably yourself as you wake up hung over after watching an episode of House and following the above drinking game.
So unlike that episode in season one of Scrubs, where the person with lupus dies, what can be done about it to increase sufferer survivability and House-episode-related joy? Well, there are actually three types of lupus, but in the end the therapies for each individual are exactly that, individualized. A balance of anti-inflammatory drugs, steroids and immune-suppressants should do the trick. Interestingly, avoiding sunlight, living a healthy lifestyle and anti-malarial drugs have been known to help manage symptoms. Although lupus isn’t curable, it can be treated and sufferers can live happy and health lives. So should there ever be a patient with lupus, you’ll know they’ll at least survive the episode.
So that’s my 2c on DOTW. I feel a little bit of immunology is a nice mix up from bacteriology and virology for all of you out there… Now I should go write my own thesis as well.
*I have no stats to support such a claim, in fact there might even be an episode where it is lupus. And if I am wrong, well. It’s never sarcoidosis either…