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Finding the Edge

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Finding the Edge is case #9 of House M.D. - Critical Cases.

Frank Ridell, a 32 year old athlete, was doing bench presses in his garage/gym with his coach Walter when he lost the ability to lift the bar and it struck him square in the chest.  However, even though there was no sign of a head injury, Frank was unable to tell the paramedics or hospital staff his own name.  His case was referred to Gregory House.

House ordered an environmental scan and the team found boxing gloves.  After using 10 heart meds and 2 thermometers, the team found out that although Frank had once been a boxer, he had never been knocked out in any of his five losses.  This ruled out brain damage.

House ordered another environmental scan, where the team had to search silouhettes.  They fond a bloody towel.  After using 4 oxygen masks, $600 of budget andward favor, the team realize that the blood is from a nosebleed.  The lack of any obstruction in the airways rules out chronic sinusitis.

House orders another environmental scan, again with the team searching by silouhettes.  This time, they find a pill bottle.  After using 10 chem meds and 1 ward favor, they realize the bottle contains experimental steroids developed in East Germany in the 1970's.  This most likely spiked Frank's blood pressure and leads the team to believe they just need to treat him with vasodilators.  It also rules out orthostatic hypotension.

Frank is treated for steroid abuse with 10 head meds, a tongue depressor and one ward favor.  When Frank is confronted about using steroids, he denies it, but Walter confirms he has secretly been slipping Frank steroids for years.  However, when Frank is given his dose of vasodilators, he feels a burning sensation and the doctors notice that his feet are cyanotic.

Frank goes code blue and has to be defibrilated

House orders a round of imaging on Frank's sternum.  After using $600 of budget and 4 IV bags, they find no trace of an infection in the recent fracture.  This rules out a staph infection.

House orders more imaging, this time of the head.  After using 2 gauze, 2 ward favors and 12 head meds, they find another fairly recent fracture in his skull.  This would explain Frank's nosebleeds and rules out encephalitis.

More imaging shows that although Frank was on steroids, his muscle mass was still wasting away.  After using a further ward favour, 3 oxygen masks and $625 of the budget, they have to rule out steroid abuse as the underlying cause of his problems.

Given the fractures, the doctors decide to focus on treatment of Frank's head trauma.  He is treated with 16 head meds, 1 oxygen mask and the team uses another ward favor.  They question Frank about why he went from a peak weight of 168 when he was boxing to barely 140 now.  In addition, Walter admits that he most likely gave Frank the head trauma while they were sparring.  Frank was taunting him and Walter didn't mean to hit him that hard.  The doctors explain that Frank is losing weight due to numerous small tumors on his kidneys.  

Suddenly, Frank suffers a seizure.  He goes code blue and has to be defibrilated.

House orders blood analysis.  After doing the analysis and using 12 body meds, 1 ward favor and 2 thermometers, they are able to rule out bone marrow transplant rejection.

A further round of blood analysis shows that Frank's potassium levels are low.  After using 12 digestive meds, 3 gauze and a ward favor, they can rule out chronic kidney disease.

More blood analysis shows a low platelet count.  After using 4 IV bags, 2 ward favors and 10 heart meds, the team can rule out ischemic stroke as a cause of Frank's symptoms.

The team treats Frank for acute lactic acidosis  with 18 chem meds and uses 2 ward favors and $650 of the budget.  They tell Frank that although the kidney tumors were benign, his kidneys are riddled with sepsis.  As a result, they cannot clean his blood of lactic acid, which has been slowly building up and destroying his muscles.  The damage to the kidneys is permanent and he will now need lifelong dialysis.  Walter is furious and tells House that he has to do something more for Frank, but House replies that sometimes there is nothing medicine can do and only time will allow Frank to recover as best he can.  

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