A Thyroid Patient Tribute to House, MD

July 25, 2012

A THYROID PATIENT TRIBUTE TO HOUSE, MD

Mary Shomon on About.com

http://thyroid.about.com/od/findlearnfromdoctors/a/thyroid-patient-tribute-house-md-television.htm

"Sometimes we can't see why normal isn't normal." ― Dr. Gregory House

....

While traditional medical dramas --think ER and Grey's Anatomy -- feature a heavy diet of car accident victims, cancer, and dramatic childbirths, House, MD was heavy on complex, difficult-to-diagnose conditions that don't often get attention. And a key feature of the show was always the process of ruling out the possibilities in order to hone in on the correct diagnosis.

There's a saying that many doctors seem to embrace: "If you hear hoof beats, it's more likely to be a horse than a zebra." But on House, MD, they were always looking for or trying to rule out the zebras, and along the way, calling attention to a variety of conditions that don't often make it into network dramas.

Frankly, House, MD may have done more to promote awareness of autoimmune, endocrine, and thyroid diseases than any other program on television. In numerous episodes, Dr. House and colleagues -- including endocrinologist and love interest Dr. Lisa Cuddy -- saw patients who had symptoms such as heart palpitations, anxiety attacks, altered mental states, and high blood pressure, and almost always ordered comprehensive evaluation for thyroid disease and various autoimmune diseases.

In the end, a number of Dr. House's patients had some form of thyroid disease, including hypothyroidism, Hashimoto's disease, hyperthyroidism, thyroid storm, even myxedema coma. Along the way, other diagnoses included autoimmune diseases like sarcoidosis, amyloidosis, lupus, Addison's disease, Guillain-Barre syndrome, and Sjögren's syndrome. Endocrine disorders also made their appearance, including polyglandular autoimmune syndrome, pheochromocytoma. House, MD also tackled controversial and frequently marginalized conditions often seen in thyroid patients, including fibromyalgia, chronic fatigue syndrome, and Epstein-Barr disease.

Since House, MD has been on the air, I can't tell you how many emails I've received from people who say they are looking for a doctor "like the guy on House" who will really delve into their symptoms and figure out what's going on. One woman even wrote to say: "Please, please, let me know...WHO is the Dr. House in the thyroid world? Who is going to be able to take my hair loss, weight gain, fatigue, depression, and 20 other symptoms, and stop telling me that my TSH is normal, and handing me a prescription for Prozac? I don't care if they have the rotten bedside manner of Dr. House -- I just need someone who won't give up! Who is it?"

That's a good question. Because in the real world we thyroid patients live in, very few doctors approach things like Dr. House. The majority of doctors we encounter hear those hoof beats, and assume it's a horse.

Uncontrollable weight gain? Easy...you're eating too much. Fatigue? What's the big deal...just get more sleep. Depression? Here, have an antidepressant!

Meanwhile, many patients have to be our own detectives, and when we come to realize that we're probably up against a thyroid or autoimmune condition -- the proverbial zebra -- it's just the beginning of a challenge. Because then we need to find a doctor willing to explore the possibilities, rule out options, and hone in on a diagnosis. That takes time, patience, and resources that few doctors can offer.

While the fictional Dr. House may have been grumpy, negative, and cantankerous, there are many thyroid patients who would give anything to find their own Dr. House. Because until real-life doctors start acting more like the fictional Dr. House, thyroid, autoimmune and endocrine disease will always be the zebra.

Edited August 3, 2013 by Altostrata
edited for fair use

July 26, 2012

Apparently the real Dr. House is the guy in this story:

http://discovermagazine.com/2007/medical-mysteries/the-real-dr-house

The Real Dr. House

Thomas Bolte solves the medical mysteries no one else can.

by Joseph D’Agnese, photography by Jennifer Karady

From the Medical Mysteries special issue; published online July 19, 2007

A woman named Ethel Moore* arose one morning in the summer of 1999 and traveled 76 miles from her home in upstate New York to see a doctor in Manhattan. Moore was 74 years old, a stylish, humble woman who looked like someone’s mom. Once in the doctor’s office, she disrobed to reveal a secret that had both plagued and embarrassed her for two years and which she had kept hidden from friends and neighbors. A hairy tan-and-brown rash covered her body from the neck

down. She had visited numerous doctors to rid herself of the affliction, but to no avail. The pathology lab of a prestigious Manhattan institution had examined biopsies of her lesions and pronounced them cancerous; her regular doctor had dutifully prescribed chemotherapy. To Moore, that felt like a death sentence. She wanted a second opinion.

Her new doctor, Thomas Bolte, thought that she was more than entitled to one. As he flipped through Moore’s voluminous medical files, he could see that something was destroying her immune system—but he did not know if it was cancer. As a young physician he had worked at a pathology lab, and he knew from experience that labs occasionally made regrettable errors. Under the microscope, a skin cell might look cancerous when it really wasn’t. Histopathology, the microscopic study of diseased tissue, is more art than science. If the lab had gotten the diagnosis wrong, chemo might kill this patient. Bolte had never seen anything like this rash in his life, but he was determined to save Moore from it.

Bolte, who today is still boyish at 45 and still working out of the small one-room office where he first examined Moore, is a doctor obsessed with mysteries. He calls himself an unusual symptoms investigator, his term for a doctor who picks up where other doctors fail. Patients find him on the Internet, and they appear in his consulting room like characters out of a foggy Sherlock Holmes story: The Case of the Migrainous Art Dealer. The Case of the Irritable College Grad. The Adventure of the Chemically Sensitive Sleeper. For fees that are astonishingly reasonable by New York standards, Bolte takes these patients under his wing and tries to ferret out the reasons for their illness. He usually succeeds.

“If a person calls our radio show and says they have a problem that no other doctor has been able to help them with, that they can’t crack the case, I refer them to Bolte,” says Jerry Hickey, a pharmacist and host of InVite Radio, a nutritionally oriented program aired on the New York City–based talk station WOR. “He’s sort of a medical detective. He looks at things out of the box, and he’s solved quite a few cases over the years.”

Bolte is obsessed with mysteries. He calls himself an unusual symptoms investigator, his term for a doctor who picks up where other doctors fail

Like the cranky character played by actor Hugh Laurie on the Fox TV series House, Bolte is a master of the differential diagnosis—identifying patients’ ailments based on a careful analysis of their symptoms. At times cases have taken the doctor into the realm of the weird, as when a patient casually informed Bolte that her psychic told her she was suffering from a parasite, specifically Entamoeba histolytica. “I didn’t know psychics knew that much about parasites,” Bolte says, “but I am always willing to keep an open mind. I said, ‘That’s fine, but why don’t we do a stool test?’” The results proved the psychic correct. Bolte, a spiritual man who is also fascinated by Jungian theory and the workings of synchronicity, chalked that one up to the importance of staying open to whatever the universe slings in your direction. The patient, of course, was miffed that she paid for lab work for the doctor to learn what she already knew.

Unfortunately, many of the patients Bolte sees are victims of iatrogenic, or doctor-caused, illness. Simply put, they have been misdiagnosed, overmedicated to the point of sickness, or given treatment inappropriate to their conditions. On occasion, this has led to shouting matches with more conventional docs, like the dermatologist colleague who burst into Bolte’s office one day and harangued him—in front of another patient—for telling the mom of an acne-ridden teen to stop feeding her child so much junk food. There’s no evidence that diet has anything to do with acne, the dermatologist shouted. Bolte begged to differ and cited the literature. “The pharmaceutical industry has trained even doctors to believe that there’s a pharmaceutical answer to everything,” he says, shrugging.

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