S2E6 - "Spin"

Zebra Factor 8/10
Final Diagnosis Myasthenia gravis , pure red cell aplasia , thymoma
Bodypart Muscles Field Neurology
Directed by Fred Gerber Written by Sara Hess
Aired on Nov 15, 2005
Rating 8.6/10
Guest Star Kristoffer Polaha
Guest Star Sela Ward
Guest Star Currie Graham

Major Events

  1. Mark Warner, Stacy's husband, starts to attend group therapy for people coping with disabilities.
  2. Wilson reveals that he cheated on at least one of his wives, which one is never specified. This is why House likes to tease Wilson or accuse him of cheating on his current wife Julie, despite a lack of proof either on or off-screen for Wilson going beyond a friendly conversation with other women while married to Julie.
  3. House breaks into the Group Therapy office and steals Stacy's personal file.

From Polite Dissent

See politedissent.

From House M.D. Guide

See the House, M.D. Guide article.

Patient

Jeff Hastert, a professional cyclist, collapsed on the track. He admits to blood doping, sleeping in a hyperbaric chamber, pumping up "electrolytes with an IV drip and herbal supplements, amphetamines, and diuretics."

Origin of the Case

Cuddy pulls him out of an uncomfortable conversation with Stacy asking that he looks at the cyclist. House refuses saying that he will just lie about taking drugs and then they will spend all their time and effort and just prove in the end it was drugs all the time.

Steps taken to Diagnose

An air bubble in his lungs (which he did have but which wasn't the problem). Then when he doesn't get better House thinks Chase "screwed up the embolectomy." Later House assumes that someone gave the cyclist EPO. Because of House's assumption Jeff fires his manager.

Ethics

Giving the patient a drug, telling him to get up and walk and not warning him that he will collapse again in a matter of minutes.

Diagnosis

Thymoma is a tumour in the thymus gland. It "hangs with.... PRCA and an auto-immune disease called myasthenia gravis. MG causes muscle fatigue, including respiratory problems and difficulty swallowing."

Clinic Patients

A flight attendant with diarrhea (which started right after he gave up smoking) who was being poisoned by sugarless gum which uses xylitol as a sweetener and sorbitol is laxative.

From House Fandom

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Summary

Stacy reacts to Mark and House's argument:

"My goodness! It's like watching Oscar Wilde and Noel Coward in the third grade! Excuse us."

―Spin

Spin is a 2nd season episode of House which first aired on November 15, 2005. A famous cyclist who admits to blood doping becomes House's patient and Cameron wants to report him for cheating. Meanwhile, House attempts to force Stacy to admit how she feels for him by going to disrupt Mark Warner's therapy group and by stealing Stacy's files from her therapist to get more insight.

Recap

Famous cyclist Jeff Forrester collapses during a charity race. He is rushed to Princeton-Plainsboro.

House, meanwhile, is close to having his license expired, and Stacy is also bugging him about his dictation and getting Cameron to do all the clerical work. Luckily, Cuddy calls House away to work on Forrester's case, but she also takes the opportunity to bug him about his paperwork. House is trying to get Stacy fired. House is convinced Forrester's problems are related to illegal drugs, but Cuddy has already ruled that out.

Forrester denies using Epo, but admits to blood doping, using a hyperbaric chamber, amphetamines, diuretics and herbal supplements. Meanwhile, House is popping a Vicodin.

House meets with his team - Forrester is suffering from respiratory distress. Foreman comes up with the idea that during his injections, he may have given himself an air embolism. House tells them to look for it. The team argues about the ethics of athletes using performance enhancing drugs. However, they do find the embolism.

Wilson and House are in the cafeteria when Mark and Stacy come in. House is telling Wilson that Stacy is "pissy", indicating she is sexually frustrated with her husband. House and Mark trade insults until Stacy wheels Mark away. Wilson tells House that Mark is in group therapy.

Chase removes the embolism, but Forrester develops a new symptom - he becomes unresponsive and starts drooling. Everyone immediately accuses Chase of screwing up the procedure, but Chase denies doing anything wrong. The new symptoms indicate a systemic weakness. House orders a full blood workup including ANA and a muscle biopsy.

Meanwhile, House crashes Mark Warner's group therapy session on the pretext he needs help with his leg.

The team discusses Forrester's cheating, and Foreman suggests to Cameron that if she really thinks something should be done, she should report him.

Naturally, House and Mark explore their adversarial relationship during therapy. The therapist throws House out of the session.

The tests are all negative, and Forrester is still showing general muscle weakness. House orders a lumbar puncture and antibiotics in the event it's an infection. Meanwhile, Forrester's manager is pushing Cuddy to speed up Forrester's diagnosis. The manager gives Cuddy a big check. The team stays late for the lumbar puncture. However, during the procedure, Forrester goes into respiratory arrest. Foreman intubates him. The lumbar puncture doesn't show anything, but Forrester's red blood cell count is dropping.

Stacy confronts House about crashing Mark's therapy. House once again puts down her attitude to sexual frustration.

Wilson tests for blood cancer, which would explain the symptoms, as would a botched procedure. During the procedure, Forrester asks if this is something he did to himself.

Wilson also finds out that Cameron has called the newspapers to tell them about Forrester's cheating. Wilson admits to Cameron that he cheated on one or more of his wives, and that telling them is what ruined most of his relationships.

Wilson reports that Forrester has anemia caused by pure red cell aplasia, but only Epo could cause it. House wonders why he would lie about not taking Epo but not the other cheating.

Cuddy finds out about the leak to the press, and Stacy confronts the team and accuses House of being the leak. However, when it turns out the leak is about the possible cancer diagnosis and not the cheating, House figures out the manager was the source of the leak, and that she was the one that injected Forrester with Epo. The manager admits to the leak, but not to injecting Epo. Forrester doesn't believe her about the Epo and fires her on the spot. However, she still denies giving him Epo and tells them their diagnosis is wrong if it's based on that.

They treat Forrester with prednisone and he starts to improve, but soon his red blood cell count is plummeting again. When Foreman mentions that he had to give Forrester a unit of blood, House is surprised and orders a scan of Forrester's neck to the confusion of the team.

House talks to Wilson about Stacy and how she burst in on him at the clinic. Wilson asks House if this is going to end well for anyone.

Despite the team's skepticism, the scan shows a thymoma (tumor of the thymus gland). House figures out his aplasia is chronic, not acute, and that the blood doping and hyperbaric chamber treated the problems by coincidence. When he stopped doing it for the charity race, the aplasia became symptomatic.

However, most patients with a thymoma also have myasthenia gravis. To confirm, House injects Forrester, whose muscle weakness immediately disappears. That was treated by his hyperbaric chamber, which he also stopped using for the charity race. However, after the drug wears off, Forrester collapses.

House goes to Stacy to apologize for his behavior, but he asks Stacy whether she loves or hates him. She answers she loves and hates him, but she only loves Mark. Stacy suggests they deal with each other.

Cameron is frustrated that the blood transfusions Forrester needs for his condition essentially gives him permission to cheat.

Cameron admits to Wilson that she once fell in love with her husband's best friend while her husband was dying. Wilson admits that his wife was fine, but he met someone who made him feel terrific and he didn't want to let the feeling go. Cameron points out you can't control your emotions, but you can control your actions, and she never acted on her feelings for her husband's friend.

We last see House breaking into the therapy room to review Stacy's file.

Clinic Patient

A recent ex-smoker comes in with diarrhea. The patient is using gum to deal with his oral fixation. House points out the sorbitol sweetener in the gum is also used as a laxative.

Zebra Factor

Although all of the conditions are rare, as House pointed out, in about 25% of cases the three are linked together.

Trivia & Cultural References

  • The episode and patient, Jeff Forrester, are heavily derived from Lance Armstrong and the controversial revelation of his doping practices, leading to his many titles being stripped.
  • House starts the episode by using various things in his office to set up a domino-like effect with the simple result of throwing his pills in his hand. This is known as a Rube-Goldberg machine.
  • Noël Coward and Oscar Wilde were both widely regarded as the wittiest men of their particular era (the late 19th century for Wilde and the mid 20th for Coward).
  • Goldilocks is a girl within The Story of the Three Bears. Also, "too old" and "too young" is a further reference to the story. The bears are a little bear, a middle-sized bear, and a huge bear.
  • At the end of the episode, Wilson is seen reading Bill James' Historical Baseball Abstract, a book about sabermetrics in baseball.

Cast