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John has an extensive history of worldwide travel.
In a period of five days, John went from 185 lb. and perfect health to losing over 30 pounds and exhibiting what appeared to be burns over most of his body and a discharge from his fingers. He also had stomach pain nausea with vomiting and anorexia. His illness was suspected to be an assassination attempt given the sensitive nature of his work. The case was assigned to Dr. Terzi who enlisted the assistance of Dr. Gregory House from Princeton-Plainsboro Teaching Hospital, one of the country’s leading diagnosticians, and Dr. Sidney Curtis from the Mayo Clinic, the country’s leading immunologist. Because most of what John did was classified information, some facts had to be withheld from the consultants.
John had already received six complete tox screens and been tested for every type of heavy metal poisoning, toxin and biological agent. Dr. Curtis noted the patient had been eating a lot of chestnuts. He surmised that someone had switched in horse chestnuts, which are poisonous. However, Dr. House dismissed the idea because horse chestnuts are very unpalatable and it was unlikely John would have disregarded the taste and it would take several hundred to poison him. Dr. House pressed for more information about where John had been, and Dr. Terzi told him that John had been in Bolivia for the past 11 months. Dr. House suggested that the only problem was alcoholism and that John had been poisoned by alcohol - it was pancreatitis. Dr. Terzi denied that John was an alcoholic. Dr. Curtis pointed out this wouldn’t explain the darkening of his fingers, but Dr. House put that down to a simple fungal infection. When Dr. Terzi pointed out the burned skin, Dr. House put it down to sunburn. Dr. Curtis thought that radiation sickness was more likely, probably from a customized isotope that would be difficult to detect and untraceable. Dr. Terzi decided to treat for radiation poisoning.
Dr. Curtis administered iodine to protect John’s thyroid gland and antibiotics to fight secondary infection. Dr. House implied that John was a drinker, but John denied drinking at all. Dr. Curtis asked why John would lie about it when he was so ill.
A few hours later, John’s vital signs had improved and his stomach pain had lessened. He had stopped vomiting, but Dr. House revealed that he had been withholding food from John, the treatment for pancreatitis. The antibiotics would have worked as well, but Dr. House had discontinued the iodine. However, when Dr. Terzi went to check John, he was in a coma.
John regained consciousness, but was in severe pain. Dr. Curtis was sure it was radiation sickness and that Dr. House had cost the patient time. However, Dr. House tried to take out some of John’s hair, but it was fully in place. Dr. House pointed out that radiation sickness kills cells in a certain order and if it was radiation, John’s hair should be falling out in clumps before he started feeling severe pain. Dr. House thought it was more likely to be blood cancer - Waldenström's macroglobulinemia. Dr. Terzi asked if they could treat for both conditions, but Dr. House advised that would most likely be fatal. Dr. Terzi agreed to treat with plasmapheresis and chemotherapy for cancer.
Dr. Terzi and Dr. House started treatment. Dr. Terzi realized they had to consult an oncologist about the chemotherapy, and Dr. House agreed to contact his colleague at Princeton-Plainsboro, Dr. James Wilson. He recommended a dose of 25mg/sq.m.
However, John’s hair finally started to fall out. John thought it might be the chemotherapy, but Dr. House realized it was happening too fast and realized it might be radiation sickness.
They started treating John for radiation sickness again. Given the severity of John’s condition, Dr. House suggested an experimental herbal treatment, ophiocordyceps sinesis. Together with dimercaprol and chelation therapy, it has been shown to reduce bone marrow damage in radiation patients in experimental tests on monkeys.
They started John on the experimental treatment by brewing a tea from the herb.
John’s nausea started to improve, but because radiation sickness has a latency period, his improvement didn’t show he was actually getting better. Dr. House and John started talking about John’s experiences during Carnival. However, Dr. House got intrigued when John told him Carnival had lasted forty days, because in Bolivia it is only celebrated for eight days. He asked John more about the chestnuts he ate.
Dr. House came with the answer. He had figured out that John was in Brazil, not Bolivia. He spoke to CIA Agent Smith who had told everyone John had been in Bolivia. He didn’t think it mattered because Bolivia is in the same region and has the same endemic diseases. However, Dr. House pointed out that Brazil uses Portuguese, not Spanish. Someone translated the Portuguese “castanhas-do-Pará” (literally chestnuts from Para) as “chestnuts” instead of their common English name “Brazil nuts”. Brazil nuts contain selenium which probably meant that John had heavy metal poisoning. In high doses, selenium causes fatigue, vomiting, skin irritation, discharge from the fingernail beds and hair loss - John’s precise symptoms. Luckily, John was already on chelation, which was the proper treatment. His lessened nausea showed he would probably recover.