House M.D. Diagnostics Test Run - Take Two.

[Antihero]

/in

[Antihero]

ask how his moods been in the last couple weeks
ask if he hears unexplained voices

[Antihero]

take t3, t4, and tsh levels

[Antihero]

/points and laughs

clarification: at tth. not at the kid. DONT HURT ME.

[Antihero]

EDIT: Also, I hope you guys enjoy the interactiveness, where I use your doctor-self for conversations. I try to keep it fun. Please let me know if I step out of line. (I'm looking at you, Antihero - though I thought you'd enjoy the vicodin joke.)

haha, nah you're good. that was funny.

[Antihero]

The pH of the urine is at 6.7, The rest of the test came back normally, with the exception of a slightly elevated presence of ketones in the urine.

there's a metabolic thing to this i just dont know what it is...

[Antihero]

there has to be something to the hypoglycemia and the ketones in the pee, right?

[Antihero]

measure heart rate and blood pressure.

[Antihero]

The pH of the urine is at 6.7, The rest of the test came back normally, with the exception of a slightly elevated presence of ketones in the urine.

there's a metabolic thing to this i just dont know what it is...

You should do a glucose tolerance test.

he already said a1c were normal, he's not diabetic

[Antihero]

do a catecholamine analysis on the pee sample.

[Antihero]

ask the parents how jimmy's last dentist appointment went, anything unusual?
ask the parents about the tonsillectomy and why it was done.

[Antihero]

Ask the parents and the patient whether he has eaten anything they haven't recently. Also ask them about their dietary habbits. (I am not quite sure whether asking the same questions to multiple people counts as two questions or one)

go ahead and ask

nix my diet question. ask the parents about the tonsillectomy and why it was done.

[Antihero]

well... the kid's bulimic

[Antihero]

for the questions...

"ok kid, time to level with me. do you purge after you eat or do you take laxatives? if so, how long have you been doing it and how often do you do it?

the reason i ask is that i strongly suspect you're bulimic. you're afraid of getting fat so you do everything you can to prevent it: exercising to compensate for what you eat, puking after you eat, taking laxatives...
if you are, it's important to fess up because you're already seeing what it's doing to your body. at least we are. you have elevated ketones in your urine; that's the result of your body metabolizing fat. you see these kinds of levels in diabetics and people in starvation states. needless to say, this is not good for your body's metabolic health. and you remember those cavities you had at your last dental appointment? your stomach acid is... well... acidic and wears off the enamel of your teeth.

now, i suspect your... irritability is just a tentacle of the bulimia, a result of the chronic hypoglycemia you keep yourself in.

it's treatable. but i won't know for sure unless you tell me."

[Antihero]

'kay, i'll take that. make that my action.

[Antihero]

Guys? Any ideas?

pretty sure he's bulimic but i dont know if that accounts for the rage. it would account for the ketones in the pee, the hypoglycemia, and the low epinephrine.

alternative is that a pheochromocytoma is dumping a ton of adrenaline into his system and makes him go apeshit berserko and the ketones were the result of his low carb diet. someone should do an MRI and/or check catecholamine levels in his serum.

[Antihero]

'kay, so there was something to the low platelet count

[Antihero]

do a total body MRI

[Antihero]

ask the kid if it takes him a long time to scab after injuries.

[Antihero]

dont worry about it, daddy's (...or mommy's... i guess i dont know who has the job...) insurance will take care of the cost.

there are a couple structural things (spleen's one, brain's another) that i just want intel on

[Antihero]

But we already know his Adrenaline (=Epinepinephrie) is down...

adrenaline gets metabolized, and the metabolite was up

[Antihero]

If I can give out one hint - you've made this a LOT harder than it is.

the primary symptom is "wanting to beat up annoying people" and thats tricky to trace back to anything medical esp in the absence of anything else neurological

[Antihero]

tapeworm in brain may be plausible?
id be wondering why he didnt have a fever or a headache.

[Antihero]

corticol atrophy

google doesn't even know what that is. please confirm you spelled that correctly.

[Antihero]

the cortical atrophy was in the head?

[Antihero]

I'm not sure how to approach cortical atrophy. If he actually has some kind of weird early-onset variant Parkinson's or Alzeheimer's, he's fucked and there's nothing we can do, so I'm going to assume this is not the case here.

well... i'm having a hard time believing this has nothing to do w/ his head. cortical atrophy would be a hell of a red herring.

prob should have just run a head mri pbttbtbththththtbhthbthbhthbth

ah well. off to the clinic for me.

[Antihero]

kuroi is house. WE'RE the goons. pester kuroi to do the update so i can stop sitting on my hands.

for the purpose of the mafia game, kuroi should probably have more well-defined action periods. there should probably be one ~12 hours, anything more infrequent is likely to be a drag.

[Antihero]

I am shooting blindly now since no one has anything
Action:

give the patient antiplatelet medication

he's already got low platelets, dude (likely b/c his spleen's enlarged)

[Antihero]

i think we should start looking at the nervous system. do whatever matt did the last go round. i'm not sure how it ties in w/ the bad circulation and the enlarged spleen but the cortical atrophy is a huge red flag.

i'm not sure if pet gonna' tell you anything tth...

[Antihero]

plus it directly ties in w/ the rage (which is the main symptom to begin with)

[Antihero]

Doctor Fake and Doctor hero come and restrain Charloux. He is locked in the closet hence unable to give the patient medication.

forget the platelet meds

do an eeg

[Antihero]

someone plz do an eeg or neurological examination

...why didn't i just do a goddamn head mri...

[Antihero]

uhhhhhhhhhhhhh....

ok

[Antihero]

Kuroi, you just made my day.

SHUT UP YOU LOST YOUR ACTION FONDLING THE GUYS BALLS

[Antihero]

if the patient has an incurable brain disease, then I will be sad

It appears that way, Dr. God. Given his age, my best guess is CJD but I suppose it could also be a freak case of early-onset Alzheimer's.

explains the white matter doesn't explain... everything else

i have a feeling i might have a problem w/ the "solution"

[Antihero]

/sigh white matter deterioration and cortical atrophy you've got:

alzheimer's
mad cow
schizophrenia

i can't think of anything else... and none of them have an obvious connection to the spleen or the circulation problems.

[Antihero]

oh yeah, and the brain eating amoeba, whatever that's called


...and maybe toxoplasmosis...? that's something that gets in the brain

[Antihero]

test for presence of white blood cells in cerebrospinal fluid.

[Antihero]

and ask the kid if has a cat.

[Antihero]

well... apparently this is really easy and i just have my fist up my ass

idgi

[Antihero]

other than alzheimer's there's really nothing that would pass the "everyone's heard of it" test in the brain degeneration category

maaaaaaaaaaaaaybe toxoplasmosis (it's the reason pregnant women shouldn't change the litter box) and maybe the brain-eating amoeba (if you keep up w/ the news; it's the reason you shouldn't use tap water neti pots) and maybe the mad cow (also if you keep up w/ the news)

[Antihero]

oh lol there's been 3 cases of mad cow in the US

good luck w/ that

[Antihero]

should i diagnose alzheimers then?

i dont know if there's a one-shot test for it, i can't find any. seems like it's a thing of "wait until they start forgetting stuff and showing other symptoms THEN it's diagnosed"

[Antihero]

If this is a mish mash game, I'd probably continue this as a once-per-day sort of deal.

i would consider maybe letting ppl do 2 actions per phase then

[Antihero]

i didn't consider MS but that's something else that could be chewing up white matter

[Antihero]

Even early onset Alzheimer's doesn't really happen before the age of 50..

Familial Alzheimer's disease (FAD) or early onset familial Alzheimer's disease (EOFAD) is an uncommon form of Alzheimer's disease that usually strikes earlier in life, defined as before the age of 65 (

usually between 50 and 65 years of age, but can be as early as 15

) and is inherited in an autosomal dominant fashion, identified by genetics and other characteristics such as the age of onset. It accounts for approximately half the cases of early-onset Alzheimer's disease. Familial AD requires the patient to have at least one first degree relative with a history of AD. Non-familial cases of AD are referred to as "sporadic" AD, where genetic risk factors are minor or unclear.

[Antihero]

fuck this round

[Antihero]

is this the part where we're supposed to drill a hole in his skull to relieve the pressure on his brain?

[Antihero]

I think it was normal because he got a lot of exercise and healthy food. He hasn't been exercising since he got admitted and also the hospital food is worse than what he gets at home.

for type 1 diabetes there's no diet or exercise that's going to keep it at bay. there's no insulin to begin with b/c the beta cells are kaput so blood sugar's going to run rampant and bump up that a1c regardless of what the kid does.

[Antihero]

And while you do that, maybe take a look at his legs as well for signs of infection or trauma or something? I mean, you're working his legs so it should be possible?

heart rate went up which means stroke volume went down. makes sense but i'm not smart enough to know what it means

[Antihero]

considering his platelets are low id be kinda surprised if there was a clot on the loose but... fuck i dont know.

[Antihero]

if there's a problem with the circulatory system
let's look at the heart

run an ekg

[Antihero]

yes

[Antihero]

khan shouldve caught this w the pancreatic test and a1c would still be high

[Antihero]

yeah im googling the type 1 diabetics who can control their blood sugar wo insulin and w the exception of unverified homeopathic crap theyre all saying no

[Antihero]

haha ignore me being a sore loser. thats how i am.

[Antihero]

you drove me to it