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The patient was admitted when his right ulnar bone broke just below his shoulder while pitching a baseball during a commercial shoot. The cause was determined to be osteopenia. This made surgery to repair the arm to the point where the patient could pitch again impossible. The most common cause of osteopenia in men the patient's age was cancer, but Dr. Wilson performed an MRI and PET Scan, which were both negative for cancer. The patient's Chem 7 panel showed poor kidney function. Dr. Cameron still thought it was cancer. However, Dr. House noted that the patient had gained 20 points since his rookie year and now weighed 195 pounds. Dr. Cameron thought this was merely bad eating habits, but Dr. Foreman believed it was likely the patient had been taking anabolic steroids. This would explain the weight gain, kidney problems and bone loss. Dr. House directed Dr. Chase to ask the patient what drugs he took and to get a urine test in any case.
The patient denied taking drugs and Dr. Chase asked for a urine sample. However, the patient refused. The patient's wife also denied he took steroids. However, Dr. Chase obtained a urine sample from the patient's urine bag.
The patient's urine tested negative for steroids, but he had elevated Beta 2 proteins, which could mean amyloidosis or lymphoma. The patient's fat pad biopsy and abdominal CT Scan were negative for cancer. Dr. House still thought it was steroids. He examined the patient and found hypogonadism, a sign of steroid use. He ordered lupron to counteract the effect of the steroids. The patient's wife objected and Dr. House advised her (falsely) that lupron is merely a type of calcium builder. Dr. Cuddy confronted Dr. House about the lie, and he had to admit that if the patient was not abusing steroids, lupron would most likely put him into respiratory arrest. However, he pointed out to Dr. Cuddy that the alternative differential diagnoses were almost all very bad.
Unfortunately, the patient was soon suffering from respiratory distress, ruling out steroid abuse. He was also suffering from impaired liver function. Dr. Foreman suggested arsenic or mercury poisoning, but Dr. House ruled out an environmental cause because the wife was not sick. Dr. Chase suggested Addison's disease, but this would not affect the patient's kidneys. However, prior use of steroids could have affected the kidneys. The treatment for Addison's was steroids, but in the patient's present state this would cause him to retain fluids because of the lack of kidney function, which would eventually lead to death. Dr. House suggested a kidney transplant.
The patient and his wife still denied he ever took steroids. Dr. House advised the patient that steroid abuse and Addison's disease were the only possible explanations and that if it was not due to these diseases, his illness was untreatable and would most likely lead to his death. The patient admitted that he was on an unknown medicine about five years ago which caused him to gain twelve pounds of muscle in four weeks. Dr. Cuddy refused to put the patient on the kidney transplant list because there was no evidence he had either Addison's or steroid related kidney failure as the test for Addison's was inconclusive (which is usually the case).
The patient's wife offered to give her kidney for transplant. Dr. House agreed to run the test to see if they were tissue type compatible even though it was very unlikely for unrelated people to be a match. The wife was a compatible donor, but she was pregnant and giving her kidney would require an abortion as she would not survive otherwise. However, the patient refused because he did not want his wife to have an abortion.
The patient developed tachycardia. Dr. Chase ordered 10 units of sub-cutaneous insulin. The patient was soon in cardiac arrest. His new symptoms ruled out both Addison's and steroid related kidney failure. They managed to stabilize the patient, but his heart rate was still 130 bpm. However, soon the patient's heart rate dropped to 40 and he did not respond to atrophine. Dr. House ordered more atrophine. The patient's potassium started to rise dangerously high. Dr. House ordered his team to contact him when the patient was stable.
Once the patient was stable, he started suffering from hallucinations. Dr. Wilson suggested that digitalis would cause the rapid change in heart rate, but the patient was not on digitalis and there was no reason for him to take it. It also would not explain the earlier symptoms. Dr. House talked to the patient's coach, who was suffering from a heart condition. He was taking digitalis for it, but noticed that his prescription bottle was almost empty. Dr. House realized the patient had tried to commit suicide by stealing and taking the digitalis. This ruled out the heart symptoms and hallucinations from being related to the underlying condition.
Dr. House told the patient he was re-scheduling the transplant. The patient got angry and grabbed Dr. House, causing the urine disposal bottle to spill all over him. The patient still objected to the abortion and threatened to try suicide again. Dr. House agreed to treat for the Addison's even though it would destroy the patient's kidney function. While trying to find a new pair of pants, Dr. House ran into the patient's wife. He told her the patient refused the transplant. The wife embraced Dr. House for support, but he wondered why she didn't mention the urine. She noticed his pants were wet, but couldn't smell the urine. Dr. House realized the wife was not healthy and the combination of lack of sense of smell, osteopinia, kidney failure, hypogonadism and liver failure pointed to cadmium poisoning. It also explained why the wife had trouble getting pregnant. Dr. Chase realized the most likely source was contaminated marijuana as it is often grown in cadmium laced soil. Both the patient and his wife had used it, but the patient was a much heavier user. They started treatment and the patient's prognosis for recovery was good.
Dr. House falsified the patient's records to show he was treated for Addison's disease because reporting the marijuana use would have cost the patient his career.