Doug Svensen is the environmental activist who was the patient in the episode Saviors.
Case History Edit
The patient was admitted after becoming disoriented and being unable to stand while he was protesting at an environmental rally, although he did retain consciousness. Dr. Allison Cameron brought the case to Dr. Gregory House. The patient had seen three different specialists. Dr. Hadley believed it might be exposure to toxins at industrial sites, but the tox screen was negative and there were no neurological, muscular or vascular abnormalities. Dr. Taub believed he might be faking because he was assaulted by police, but Dr. Cameron pointed out there was no way he would fake merely to see a diagnostician. Dr. House ordered a vestibular caloric test to see if his balance problems were located above or below the neck and ordered Dr. Cameron to perform it as Doug was her patient. Dr. Cameron performed the test by putting ice water in the patient's inner ear - eye movement would indicate an inner ear problem. The patient requested that a rose be removed from his room as he objected to cultivated flowers because of the pesticides used on them. The patient experienced the sensation of tumbling and vomited.
Dr. Cameron reported that despite the vomiting, the patient's calories were fine and he still couldn't balance himself. Dr. House agreed with Dr. Cameron's analysis that the patient wasn't faking - if he was he probably would have taken pains not to vomit on Dr. Cameron. Dr. Foreman believed the symptoms were the result of stress and carotid atherosclerosis. This would not have shown up on the scans and, if correct, would mean the patient was likely to have a stroke. Dr. House ordered a carotid doppler, and again ordered Dr. Cameron to perform the procedure.
During the doppler test, the patient reported having spells of hiccuping that lasted several hours for most of the past week. His previous doctors had dismissed its importance. However, Dr. Cameron believed they may be indicative of an underlying condition and serious. Dr. Cameron pointed out how the hiccups were not related to a heart or arterial problem. Dr. Hadley believed a brain disorder might connect the two problems. Dr. Cameron thought it might be organophosphate poisoning, but Dr. Foreman pointed out the patient would have digestive tract problems and hypersalivation. Dr. Taub thought it might be multiple sclerosis. Dr. House ordered a lumbar puncture to check for MS, but Dr. Cameron pointed out a lumbar puncture would be dangerous on a patient with hiccups. However, Dr. House ordered her to do the test in any case.
Dr. Foreman agreed to hold the patient in position while Dr. Cameron did the LP. However, the patient still moved when he hiccuped. Dr. Cameron went to obtain chlorpromazine sedate the patient. Dr. Foreman noted that this would be risky if the patient had a neurological disorder. Dr. Cameron sedated the patient and was about to perform the LP. However, Dr. Foreman noticed nodules on the patient's neck.
The nodules ruled out MS. The sounds from the nodules were caused by an air link between his lungs. Dr. Taub thought it might be caused by neck spasm, but Dr. Cameron thought the problem was there all along and just wasn't noticed until it became worse. Dr. Foreman though it was sarcoidosis from exposure to pine forests, but his ACE levels were normal. Dr. Hadley thought it might be progressive systemic sclerosis, an autoimmune disease, from exposure to industrial toxins. Dr. House ordered methylprednisolone, a steroid.
However, several hours later, the patient has acute onset severe left leg pain. Dr. Hadley thought it might be an aneurysm. Dr. House thought it might be metabolic bone disease. Dr. Taub thought it might be osteomyelitis. Dr. House realized if it was an infection, the steroids would make it worse. Dr. House ordered a set of x-rays to look for osteomyelitis despite the fact that Dr. Cameron had already performed a full set. The x-rays revealed a fractured femur. Dr. Hadley noted that these are extremely rare - the femur is one of the hardest bones in the body and he broke it while lying in bed.
Dr. Hadley thought it might be osteogenesis imperfecta. However, this wouldn't cause hiccups and it would have discolored the patient's sclera. Dr. House thought it might be cancer, but not bone cancer. Dr. Hadley agreed given the patient's exposure to environmental toxins. Dr. House ordered that the break be repaired and that they start chemotherapy despite not being able to confirm the cancer diagnosis. Dr. Chase performed surgery to repair the break, and at Dr. Foreman's request performed a bone biopsy.
The biopsy ruled out bone cancer. However, the surgical incision started to bleed badly and Dr. Foreman noticed signs of internal bleeding in the other leg. Dr. Foreman ordered 2 units of FFP. Dr. House still believed it was cancer, but they still could not determine where it was. Dr. House ordered total body irradiation. Dr. Hadley pointed out that the previous steroid treatment had already weakened his immune system, and Dr. Foreman noted that the radiation could destroy his immune system altogether. However, Dr. Taub suggested giving the patient insulin like growth factor to make the cancer bigger so they could find it. Dr. House agreed to the proposal.
The patient agreed to the treatment, but soon went into detac and had no pulse. Dr. Taub used a defibrillator on the patient and managed to restore the patients heart rhythm. The patient was transferred to intensive care. The echocardiogram was normal and the patient tested normal for myocardial ischemia. This added tachycardia to the list of symptoms. Dr. House wanted to implant a permanent defibrillator, but Dr. Foreman objected. Dr. House insisted.
There was no sign of infection, and it was not a metabolic or autoimmune disorder. However, before the defibrillator went in, Dr. House realized the patient may have been exposed to roses. He admitted buying roses for his wife three weeks previously in order to make up for a missed anniversary dinner, but she wasn't home. The patient contracted sporotrichosis from the roses. This caused lesions on his nerves which caused his initial symptoms. It spread to his bones and heart because of the use of steroids and growth factor. The patient would recover.