UPDATED: A "House" Diagnostic Puzzle for You All

You are on Dr. House's team. Patient: Ellen S_______ presents as an overweight Caucasian white female complaining of:

• diarrhea

• nausea

• vomiting

One of you (probably the bi-sexual one, you know who you are), asks: "Swine flu? Does she have a cough?"

Patient wheezes, "I coughed once today at a big meeting, and it was so disgusting the entire meeting of 300 people stopped cold, including the speaker. It was a cough followed by a strangling hacking sound."

You, the team, write down "Cough." and ask, "How did you feel when you woke up today?"

Patient answers, "Achy. I was achy all day."

"What about the last few days?"

"Well, I slept a lot on Sunday. Saturday I got a lot done. I was hoarse Saturday morning, but I'd been screaming a lot Friday. Friday I was okay, only sleepy. "

"What did you eat for dinner last night?

"An entire container of Planter's Honey-Roasted Cashews."

"Anything else you can think of?"

"Well ... last weekend my right inner labia swelled up and then exploded."

You hear another team member mutter, "TMI" You ask, "Anything else..."

"No. Not really. You know I'm on immune-suppressing drugs?  FTY720?"

Someone else on your team writes that down.

House looks into the distance and then suddenly exclaims in wonder at his own deductive brilliance, "That's an MS drug! MS! It's MS!"

You say, "No, that's not it," because you are smart. (No one is ever smart enough to say this on House, they always say, "Oh, yeah, MS will cause your leg to atrophy overnight, or make your vulva fall out, or cause your bones to shatter." Then they will give you a lumbar puncture because that's so much easier than an MRI.)

"Put her on steroids! And interferon! And do a brain biopsy!"

"No," Foreman says.

"Hey," Becs interrupts, "Didn't I write this same post a month or so ago?"

"Yes," Dr. House snaps shortly, "But you don't have MS, so we can't do a brain biopsy. One final question. Does the patient have a fever?"

Cameron says, "Her temperature is 98.4" (This is trivia, but my temperature is always 97.0. I don't know if 98.4 counts as a temperature. Is it like a 100 degree fever in normal people?)

The Patient runs to the bathroom again, clutching her stomach.

So, you get to diagnose Patient Ellen. What is your diagnosis? The flu? The Swine flu? MS? Something else?

You have all the information you need to make a diagnosis. Leave your diagnosis in the comments. The answer will be provided tomorrow night. If you want to ask more questions, leave it in the comments, and if I take a break at work tomorrow I'll answer. Have at it!

==============================================

UPDATE:

Suddenly Dr. House turns and says:

So, let's look at this chronologically Her right inner labia swells, no doubt painfully, and then explodes.That was the first weekend, and I think it's pretty obvious she spent part of the next weekend using her newly-recovered body part. She spent Friday night screaming, but she made no mention of a fight, let's just put it that way.

House wiggles his eyebrows lecherously.

So her husband gave her such a workout Friday she had the urge to clean the house Saturday, and then sleep all day Sunday. As you pointed out, Dr. Hall, she has some type of infection. But what type of infection? Becs, do you have an answer?

Becs looks unsure.

Anyone else? Anyone with MS? No one? She has a blad-der in-fec-tion.

==============================================

Evidently my body has become immune to bladder pain, or else I drank enough fluid over the weekend and on Monday to dilute the uric acid and mask the pain. It wasn't till sometime late Tuesday when I went to the bathroom and said, "Ow! Oh! Oh, of course, I had sex. That's whats wrong with me."

And the cashews? I'm just a pig. This morning my temperature was down to 96.5 and I feel much better.

Comments

[Shania]

I hope you get a diagnosis soon. So all the people at work that come down with it next week will know what they've got!

A make out session with Dr. House should fix you right up. You'll absorb some vicodin, at least.

[#0.75]

I need to use your bathroom. I think the answer is in there.

[Christy]

Cadmium poisoning (ingested, not inhaled). Probably from the peanuts. We can chelate you, or put you on hemodialysis, but I suspect a mild case, so it should spontaneously resolve in a few days.

[Mrs. Hall]

I have MORE QUESTIONS I NEED ANSWERED BEFORE I DIAGNOSE.

sent you an email, and once you tell me I TELL YOU

:)

[Angie]

My guess is it's some sort of worm/parasite thing. Or you're a dude. Those are the only House things I recall off the top of my head.

[gaoo]

Did the team illegally search your house yet?

[Thequeen]

Shania - he is so smart-I likes me the grumpy smart boys
.75-if you and foreman searched my bath room you might find a clue under the sink.
Christy -good guess but that only explains a few of the symptoms. I need the big aha answer.
Mrs Hall - to even the field, there is one symptom that made it all clear later nut I'm not telling
Angie/-not a dude. Not a parasite or worm
Gaol-well...you have all the info on the blog the team would have found in the house.at least ok the blog somewhere

[Caroline]

The sink, eh? Perhaps you drank unfiltered water instead of that special faucet you have in the kitchen and you have lead poisoning.

[Tami]

I had a diagnosis, but it was, um... not fit for internet viewing. Anyone can see this stuff!

[Mrs. Hall]

Let's walk down the path of diagnostics, REAL diagnostics shall we? (ya'll can skip to the end for the answer)

Symptoms of cough, n/v diarrhea, tiredness, fever (and it's best friend-achy all over), swelling and exploding labia complete with puss/blood are all related to some infection/pathogen.

Coughing, n/v, swelling/exploding, fever- these are the ways our immune system react to infections. Our bodies eject or cook various pathogens, thereby eliminating them. It is poetry of the immune system in motion.

But what? What could be the pathogen?

So, lets go further

1. Violent n/v, diarrhea is usually gastroenteritis. The GI tract swells in response to a pathogen and then process to eject it from every which way it can. It is the horror film of the stomach and bowels. And painful with the cramping and holding of the belly. My condolences. The cause or where you picked up the pathogen can be anywhere, the can of nuts, using the restroom at work earlier that day. And with your are predisposed towards dramatic GI events (by history and immunosupression) well, you were a sitting duck.

2. Now, RUBS CHIN, SLITS EYES, the cough you coughed sounded um, horrible. Loud, disgusting. AGAIN I WOULD LIKE TO KNOW IF YOU HACKED ANYTHING UP BUT WHATEVS. Either way, coughs come from two places, upper respiratory (sinus, throat), lower respiratory (lung infection-pneumonia). I believe it may be lower respiratory because sinus drainage, tickle the throat type cough is more chronic cough. So when the dumb doctors asked, "cough?" you would have said, "Yeah, been coughing for a few days, worse at night" instead of what you said, "Spontaneous disgusting and strangling sound after cough." More lower resp. This is no good; this indicates a more systemic type infection.

3. Finally the labia. You are immunosuppressed and you are prone to infections. The immunosupression might explain why your fever only reaches so high, because the fever is part of the immune response, which is being suppressed. Either way, you have had UTI's in the past. Infections in this area, not new for you. BUT, it exploded. This indicates to me that the infection was more severe this time. Which means it meant business.

4. And no, this is not a flare up of the MS. I mean, I could be, r/t to the MS in that the nerves that regulate the GI tract may be all wonky and really not working as well as they should, could be the drugs because any drug can cause any side effect at any time, but no. This is least likely.

So, basically either it is a case of gastroenteritis r/t picking up a pathogen (viral versus bacterial) or systemic infection (that started with the labial explosion).

I guess the latter because come on, this would be much more interesting.

WEE HEE!!! Go ahead, gimme another!! Although not now, I have to get back to my real patients :)

[Becs]

You wuz sick puppy. Dere. Dat's it.

[Christy]

I'm going with Toxic Shock Syndrome.

[Overflowing Brain]

Pregnant. That's my guess.

Because I have already guessed everything I can.

Or cashew allergy.

[Big Dot]

You're at work? With all those symptoms? Never mind the diagnosis, put a tape across Queen's cubicle and clear the building, people!

[Thequeen]

Caroline -nooope
Tami - do you think I'm shy
Mrshall -you give me fever equals infection? Come on! Not wrong but not a tidy package
becs- you probably guessed it already
Christy- no - haven't menstruated for years. Freaked a bit at the blood
overlowing brain -cashews?nooooo
big dot -not contagious! Big hint!

[Overflowing Brain]

Honey allergy? Botulism from honey?

Botulism is kickass I hear.

[#3]

Clearly, it's Leprosy. Do not leave body parts in my cube.

[Big Dot]

How about hypochondria with a side of toxic cashews?

[TheQueen]

Overflowing Brsin - Oh! That would have been good. Very creative.
3 - Cannot believe you didnt get this.
Big Dot - Nope! Answer's at the end.

[#3]

Your bladder has leprosy. Do NOT drop your urethra in my cube.

[Big Dot]

Not fair! That cough was a red herring.

[#3]

I'm going to have to agree with Dot. Presenting the cough implied a symptom when in reality it was incidental. And really gross. (But not as gross as the exploding labia. Is Gary made of sandpaper?)

[Angie]

Well this does go back to a classic House issue, which is that sex effs you up. I would take an exploded labia to do House, though.

[Tami]

You're not shy, I am. I was gonna guess dysmenorrhea, since *I* used to get those symptoms every time Aunt Flo came to town.

Bladder infection, though - just pee after sex, woman!

[gaoo]

Gosh, even I am all forehead-slapping over the bladder infection, and I've never met you and only followed the sad story of your labia for a few months. Mrs. Hall rocks.