This article is about the professional cyclist patient in Spin. For other characters by the name of "Jeff" or "Jeffrey", see Jeffrey.
Jeff Forrester is a professional cyclist who was the patient in the episode Spin. This character is loosely based on the former famous cyclist, Lance Armstrong.
Medical History[]
Jeff regularly did blood doping and various other things such as sleeping in a hyperbaric chamber to help him win.
Case History[]
Jeff is in first place in a charity cycling race when suddenly he starts panting, becomes disoriented and falls off his bike.
Dr. Cuddy gives the case to Dr. House. She tells him that Jeff had respiratory arrest while riding at 30 miles per hour. His oxygen stats were well below normal, but there were no signs of lung infiltrates. Dr. House reminds Dr. Cuddy that professional athletes are like watching an old movie at 2 AM; the part where he denies the drugs, the part where the good guys ride in, tests a-blazing proves that it is drugs, he can imagine how the drugs got in him. However, Dr. Cuddy tells him that Jeff isn't denying using drugs and that he's probably really sick. Dr. House meets Jeff, and confuses his manger for a family member. Jeff denies using erythropoietin because there are too many guys dying from strokes from using it. He admits blood doping, and he usually sleeps in a hyperbaric chamber. He also pumps up electrolytes with an intravenous drip and uses anabolic herbal supplements and diuretics. He knows that doping has risks and is outside the rules, but he claims he does it to do well at his job. However, during the charity ride, he did not take these preparations as it was not important if he won.
Dr. House brings the case to his team. Instead of a list of symptoms for one cause they have a list of possible causes for one symptom - respiratory distress. Dr. Foreman thinks it's the doping - extra red blood cells cause clots which reach the lungs. However, the patient's spiral chest CT scan was clear. Cameron thinks it's the hyperbaric chamber causing cell damage in the lungs, but Dr. House points out that this would also cause pulmonary edema. Dr. Chase thinks it's the supplements - yohimbe can cause nerve paralysis. But the tox screen was normal; all the tests were normal. Dr. Forman finally realizes it might be an air bubble embolism. House orders a VQ scan and a check of his veins for air bubbles.
Dr. Foreman gives the patient radioactive xenon gas to track the air flow in his lungs and inject him with a tracer to track his blood flow. Good air flow with bad blood flow indicates an embolism. Jeff knows the risk of air bubbles, but thinks he's careful with the needle. Dr. Foreman tells the patient that he believes his problems are due to the things he does to win. Dr. Cameron and Dr. Chase argue about the ethics of the drugs, but Dr. Foreman doesn't really care because it's only a sport. They find the air bubble in a vein in his lungs. Dr. Chase reports the result and recommends a Soren-Ganz catheterization to remove it.
Chase performs the procedure, finds the bubble, and sucks it out. Jeff is complaining that his legs feel week, but Dr. Chase puts it down to the sedative he took for the test. He gets Jeff to sign an autograph, but while Jeff is signing it he starts drooling and can't swallow.
Dr. Chase reports the patient has muscle fatigue in his neck and jaw. He believes that it indicates another underlying condition, but Dr. House believes it might be nerve damage from the catheterization Dr. Chase performed on the patient. However, Dr. Chase points out his legs were tired too, and if that is connected, it could be something systemic and unrelated to what the patient has done to himself. Dr. Chase suggests lupus or polymyositis. Dr. Cameron thinks it might be ALS, but Dr. Foreman thinks he's too young for it. However, muscular dystrophy would also fit. Dr. House a full blood work-up including ANA for Lupus and a muscle biopsy to determine whether it is a myopathy or neuropathy.
Dr. Cameron takes a sample from the thigh, and Dr. Chase wonders if she did that because it would hurt so much. Dr. Foreman wonders why she isn't just reporting Jeff to the cycling federation. However, the patient continues to get weaker, becoming unable to move his limbs despite there being no nerve damage. The biopsy is negative for polymyositis, ALS and muscular dystrophy. The ANA is negative for Lupus. House wonders why all the patient's tests are normal despite the fact that he is doing everything he can to win. Despite the blood doping, his red blood cell count is normal. Dr. Chase thinks that perhaps normal for most patients is actually elevated for Jeff. Dr. Forman points out that if this is the case, his white blood cell count is up too, which would point to an infection. Dr. Chase thinks it might be encephalitis and Dr. House orders a lumbar puncture and broad-spectrum antibiotics as they have no other working theory.
Jeff's manager complains to Dr. Cuddy about how slow the process is, but Dr. Cuddy points out he has already had several procedures and is scheduled for anther at 10 AM. The manager hands Dr. Cuddy a large donation and Dr. Cuddy arranges to have the patient's lumbar puncture done that evening.
Dr. Foreman and Dr. Cameron perform the lumbar puncture to determine what kind of infection the patient might have and administer antibiotics. Suddenly, Jeff goes into respiratory arrest. Dr. Cameron is incredulous as his respiratory symptoms disappeared after Dr. Chase's procedure. Dr. Foreman intubates the patient. The patient is put on a respirator.
The LP is negative for encephalitis, the white count is still the same but the red count has fallen to 29%. Dr. Chase believes this proves he did not screw up the procedure. However, either Dr. Chase damaged a blood vessel during the procedure or Jeff may just not producing blood in which case he's got acute anemia combined with a muscle disorder. Either Dr. Chase screwed up, or Jeff has cancer.
Dr. Wilson gives Jeff a bone marrow biopsy to test for cancer. He tells the patient that the only other alternative seems to be that he was hurt during one of the tests done at the hospital. Jeff asks for a writing pad to ask if he did it to himself. Dr. Wilson tells him that it's possible.
Dr. Wilson asks Dr. Cameron why she got a call from the New York Times and she admits she wants to tell them about Jeff's doping but Dr. Wilson stops convinces her not to.
The tests are negative for bleeds, which shows that Chase did not hurt the patient, but means he has cancer. However, the biopsy shows he's got pure red cell aplasia. Since it came on suddenly, they figure the patient could be lying about being on Epo. Dr. Cuddy tells them that they've got a leak to the press and that Jeff is threatening to sue. Stacy Warner is going to start watching them. However, the leak is about Jeff having cancer, which would seem to rule out Dr. Cameron as the source of the leak. House figures the patient on Epo and covering it up. House tells Jeff he has pure red cell aplasia. Dr. House removes the respirator so he can speak. The aplasia is acute and is caused by drugs, usually Epo. Jeff denies using Epo. House thinks that the manager is giving it to him surreptitiously. He asks if she handles any of his injections. She tells House to test for it but Epo is undetectable after 6 hours. He does however figure out that she is the one who leaked the cancer story. The manager confesses to being the leak, but denies giving him Epo. Jeff says that it could kill him. Jeff fires his manager. The manager says that the doctors are going to kill him because she didn't give him illegal drugs.
They administer prednisone and the patient's breathing starts to improve. However, Jeff's red blood cell count drops to 16%. As the patient is not improving, it would appear to rule out Epo as the cause of his symptoms. Dr. Chase thinks it is Lambert-Eaton, but Chase wants to run an electromyography test despite the fact the patient's chest was clear. However, Lambert-Eaton does not explain the aplasia. Dr. Foreman reported his red blood cell count was up to 30% because he gave him a transfusion. Dr. House asks why he needed a transfusion. he tells the team to go and scan Jeff's neck. They do the scan and find a thymoma. Foreman asks House how he knew to scan the neck, and Dr. House tells him he knew it wasn't in his chest because they'd been looking there the whole time. Chronic aplasia, although it takes a lot of time to develop and would have needed regular blood transfusions to keep him alive. Therefore the blood doping had saved his life and hidden the aplasia. He was treating himself without knowing it. Most chronic aplasia is caused by a thymoma, so he went to look for one outside the chest and the neck was the only option.
Dr. House goes into Jeff's room. Jeff says that he isn't getting better. Dr. House gives him a needle of tensilon and tells him he's healed and tells him to walk. Jeff finds he can move his arms, gets out of bed and starts walking. House explains a tumor on his thymus gland caused the aplasia and myasthenia gravis which causes muscle weakness as well as difficulty breathing and swallowing. His blood doping treated the aplasia and the treatment for MG is a hyperbaric chamber. It was the break in his regular routine that brought on his symptoms. House tells him he can rehire his manager because she did not give him Epo, and that nothing else he did caused his problems. Jeff decides not to rehire his manager. They still have to remove his thymus gland because he doesn't need it to live - they can manage the rest of the symptoms. House tells him that the shot didn't cure him, it merely erased the MG symptoms for 5-6 minutes. Jeff collapses on the floor well before that deadline.
They schedule surgery to take out Jeff's thymus gland and is given permission to take blood transfusions and use a hyperbaric chamber to treat his remaining symptoms. Jeff is last seen talking on TV thanking Dr. House and the staff at Princeton-Plainsboro Teaching Hospital. Dr. Cameron is dismayed that he continues to get to cheat.