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James Sidas

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== Case History ==
 
== Case History ==
{{Dialogue a-b|Beringer|Come on, man. This is the most exciting thing that's happened in this place in years. [Sidas sighs and takes the pen. He starts to sign but his hand shakes. He drops the pen a couple of times. Beringer chuckles.] Come on. Don't be like that. I'm paying you a compliment.|James Sidas| It's... It's not that, um... My hand's not working.|Sidas exhibits [[ataxia]]}}
 
   
 
Sidas was admitted to hospital when he found himself disoriented and unable to control the movement of his hand. On examination, he was found to have [[ataxia]], [[anemia]] and a mild [[cough]]. His [[CT Scan]] was clear and his [[tox screen]] was negative. [[Remy Hadley|Dr. Hadley]] thought it might be a [[virus]] like [[West Nile virus]]. However, Sidas had no [[fever]] and his [[lymph nodes]] weren't swollen. [[Chris Taub|Dr. Taub]] thought it might be [[hyperbilirubinemia]], and [[Robert Chase|Dr. Chase]] thought it was [[meningitis]]. Dr. Taub suggested [[sickle cell anemia]] even though the patient was of European descent. [[Eric Foreman|Dr. Foreman]] thought it was [[Thrombotic thrombocytopenic purpura]] and Dr. Hadley and Dr. Chase agreed. Dr. House cut off the discussion and ordered a [[blood smear]] to confirm and a test of his [[ADAMTS13]] [[antibodies]].
 
Sidas was admitted to hospital when he found himself disoriented and unable to control the movement of his hand. On examination, he was found to have [[ataxia]], [[anemia]] and a mild [[cough]]. His [[CT Scan]] was clear and his [[tox screen]] was negative. [[Remy Hadley|Dr. Hadley]] thought it might be a [[virus]] like [[West Nile virus]]. However, Sidas had no [[fever]] and his [[lymph nodes]] weren't swollen. [[Chris Taub|Dr. Taub]] thought it might be [[hyperbilirubinemia]], and [[Robert Chase|Dr. Chase]] thought it was [[meningitis]]. Dr. Taub suggested [[sickle cell anemia]] even though the patient was of European descent. [[Eric Foreman|Dr. Foreman]] thought it was [[Thrombotic thrombocytopenic purpura]] and Dr. Hadley and Dr. Chase agreed. Dr. House cut off the discussion and ordered a [[blood smear]] to confirm and a test of his [[ADAMTS13]] [[antibodies]].
   
 
[[Image:Sidas' Book.png|thumb|250px|left|Back Cover of Sidas' Book]]
 
[[Image:Sidas' Book.png|thumb|250px|left|Back Cover of Sidas' Book]]
Dr. Hadley reported the diagnosis to Sidas and [[Dara Sidas|his wife]]. She told them TTP wasn't curable, but it was treatable. Dr. Taub started to ask why he wasn't working at a better job, but Sidas realized that Dr. Taub was trying to find out if he was an [[alcoholism|alcoholic]] or drug [[addiction|addict]]. Dr. Taub also asked if he had a history of [[mental illness]]. Sidas assured him he was working as a courier by choice and he was happy doing it.{{Dialogue a-b-a|Taub|Didn't you think there was something weird about that guy?|Thirteen|Not really. In fact, he seemed pretty normal.|That's my point. Guys with IQs off the chart are usually completely... abnormal.|Taub wonders about the patient's mental state}}
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Dr. Hadley reported the diagnosis to Sidas and [[Dara Sidas|his wife]]. She told them TTP wasn't curable, but it was treatable. Dr. Taub started to ask why he wasn't working at a better job, but Sidas realized that Dr. Taub was trying to find out if he was an [[alcoholism|alcoholic]] or drug [[addiction|addict]]. Dr. Taub also asked if he had a history of [[mental illness]]. Sidas assured him he was working as a courier by choice and he was happy doing it.
   
 
Dr. Taub asked Dr. Hadley if she found anything odd about Sidas. She said he seemed normal, but Dr. Taub said that was the problem - people with high IQs generally don't act normal. Sidas's blood tested positive for schistocytes, confirming TTP. However, Dr. Taub thought it wasn't the whole story - the case was too easy for Dr. House. He figured there was another condition and Dr. House was testing his fellows to find out if they would catch on.
 
Dr. Taub asked Dr. Hadley if she found anything odd about Sidas. She said he seemed normal, but Dr. Taub said that was the problem - people with high IQs generally don't act normal. Sidas's blood tested positive for schistocytes, confirming TTP. However, Dr. Taub thought it wasn't the whole story - the case was too easy for Dr. House. He figured there was another condition and Dr. House was testing his fellows to find out if they would catch on.
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Dr. Taub and Dr. Chase did the environmental scan. Dr. Chase found [[ibuprofen]], nose drops and cough syrup. Dr. Taub found signs of mice and realized [[leptospirosis]] could have caused the ataxia and anemia, but Dr. Chase thought he would have to have a fever. They also found his old physics notebooks which were at least 14 years old. Dr. Taub realized that Sidas was passionate about physics in his youth and couldn't figure out why he gave it up. However, Dr. chase then noticed an air vent was loose and found a large empty vodka bottle.
 
Dr. Taub and Dr. Chase did the environmental scan. Dr. Chase found [[ibuprofen]], nose drops and cough syrup. Dr. Taub found signs of mice and realized [[leptospirosis]] could have caused the ataxia and anemia, but Dr. Chase thought he would have to have a fever. They also found his old physics notebooks which were at least 14 years old. Dr. Taub realized that Sidas was passionate about physics in his youth and couldn't figure out why he gave it up. However, Dr. chase then noticed an air vent was loose and found a large empty vodka bottle.
   
The screen for other toxins was also negative. Dr. Chase thought it was [[liver]] failure from [[alcohol]]. Dr. House ordered Dr. Taub and Dr. Hadley to do a liver [[biopsy]] even though they were about to leave for Thanksgiving.{{Dialogue a-b-a|Thirteen|Renal failure. Explains the anemia. If he developed hyperkalemia, that would explain the ataxia. But the stroke?|Taub|Ischemic encephalopathy.|Nice. Except now we have to stay and test his kidneys. |Thirteen ruins the rest of Thanksgiving}}
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The screen for other toxins was also negative. Dr. Chase thought it was [[liver]] failure from [[alcohol]]. Dr. House ordered Dr. Taub and Dr. Hadley to do a liver [[biopsy]] even though they were about to leave for Thanksgiving.
   
 
Sidas denied being an alcoholic, but his wife was surprised he drank at all. Dr. Taub performed the biopsy, but Sidas thought it was a waste of time. However, the results showed no [[cirrhosis]], [[scar]]ring or [[infection]]. The [[blood tests]] showed only one abnormal result, an [[albumen]] level of 7.2. That could be explained by [[kidney]] failure. It would also explain the anemia and if he developed [[hyperkalemia]] it would explain the ataxia. The stroke could be explained by [[Cerebral hypoxia|ischemic encepalopathy]]. However, they realized they would have to stay to test his kidneys.
 
Sidas denied being an alcoholic, but his wife was surprised he drank at all. Dr. Taub performed the biopsy, but Sidas thought it was a waste of time. However, the results showed no [[cirrhosis]], [[scar]]ring or [[infection]]. The [[blood tests]] showed only one abnormal result, an [[albumen]] level of 7.2. That could be explained by [[kidney]] failure. It would also explain the anemia and if he developed [[hyperkalemia]] it would explain the ataxia. The stroke could be explained by [[Cerebral hypoxia|ischemic encepalopathy]]. However, they realized they would have to stay to test his kidneys.
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Dr. House was away the following day so Dr. Foreman started the new differential for kidney failure. Dr. Hadley thought it might be [[rhabdomyolysis]], but there was no [[edema]]. Dr. Chase thought it might be multiple [[myeloma]], but there was no [[bone]] [[pain]]. He then suggested [[polycystic kidney disease]], but there were no [[Urinary tract infection|UTIs]] or flank pain. Dr. Chase started thinking about the cough the patient had at admission. Dr. Hadley said the patient wasn't coughing now, but Dr. Chase had also found cough syrup. Dr. Taub thought it might be [[Goodpasture's syndrome]], which would affect the kidneys and [[lungs]]. Dr. Foreman wanted to start him on [[immunosuppressants]] and [[dialysis]]. Dr. Hadley wanted to check with Dr. House, but as the rest of the team was in agreement, they decided that it wasn't necessary.
 
Dr. House was away the following day so Dr. Foreman started the new differential for kidney failure. Dr. Hadley thought it might be [[rhabdomyolysis]], but there was no [[edema]]. Dr. Chase thought it might be multiple [[myeloma]], but there was no [[bone]] [[pain]]. He then suggested [[polycystic kidney disease]], but there were no [[Urinary tract infection|UTIs]] or flank pain. Dr. Chase started thinking about the cough the patient had at admission. Dr. Hadley said the patient wasn't coughing now, but Dr. Chase had also found cough syrup. Dr. Taub thought it might be [[Goodpasture's syndrome]], which would affect the kidneys and [[lungs]]. Dr. Foreman wanted to start him on [[immunosuppressants]] and [[dialysis]]. Dr. Hadley wanted to check with Dr. House, but as the rest of the team was in agreement, they decided that it wasn't necessary.
   
They told Sidas he would need to be on dialysis for 4-6 hours a day until they saw improvement. If they didn't see improvement, he would need a [[transplant]].{{Dialogue a-b-a|House|You're stupid|James Sidas|Well, I'm rubber, and you're glue|He's not pedestrian, he's stupid. At least stupider than he should be. He's a DXM junkie.|House gets to the root cause of the problem}}
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They told Sidas he would need to be on dialysis for 4-6 hours a day until they saw improvement. If they didn't see improvement, he would need a [[transplant]].
   
 
However, Dr. House returned to the hospital realizing that Sidas' lack of intelligence was the sign of [[dextromethorphan]] abuse. He was deliberately using it to lower his intelligence as it was cheap and widely available. However, he would suffer permanent brain damage unless he also used alcohol to counter the effect, explaining the vodka bottle. He admitted he did it to feel less miserable. Dr. House told him that the dextromethorphan abuse explained all his symptoms. Dr. House ordered a [[lavage]] of his [[small intestine]] and [[activated charcoal]] to remove it from his system.
 
However, Dr. House returned to the hospital realizing that Sidas' lack of intelligence was the sign of [[dextromethorphan]] abuse. He was deliberately using it to lower his intelligence as it was cheap and widely available. However, he would suffer permanent brain damage unless he also used alcohol to counter the effect, explaining the vodka bottle. He admitted he did it to feel less miserable. Dr. House told him that the dextromethorphan abuse explained all his symptoms. Dr. House ordered a [[lavage]] of his [[small intestine]] and [[activated charcoal]] to remove it from his system.
   
 
[[File:Toroidal Helicon Plasma Device.png|thumb|250px|left|Schematic for a Toroidal Helicon Plasma Device]]
 
[[File:Toroidal Helicon Plasma Device.png|thumb|250px|left|Schematic for a Toroidal Helicon Plasma Device]]
Sidas started to improve and he began work in applied physics, "doodling" a schematic for a toroidal helicon plasma device. However, he confided in Dr. Foreman that he was feeling miserable again and that he felt less attracted to his wife. He admitted he was a jerk and he owed her everything, but he didn't want to be with her.{{Quote|I told you. Do you know what the difference between her IQ and mine is? 91 points. In relation, she's closer to a gibbon than she is to me. Having sex with her would be an act of bestiality.|Sidas regains cynicism along with his intelligence}}
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Sidas started to improve and he began work in applied physics, "doodling" a schematic for a toroidal helicon plasma device. However, he confided in Dr. Foreman that he was feeling miserable again and that he felt less attracted to his wife. He admitted he was a jerk and he owed her everything, but he didn't want to be with her.
   
 
Even his wife realized that he had changed and didn't want to be with her anymore. Dr. Foreman tried to assure her that it was just [[withdrawal]] symptoms. However, Sidas called for help. He said he couldn't feel anything in his legs. Dr. Foreman realized he was unresponsive to stimuli - [[paralysis]].
 
Even his wife realized that he had changed and didn't want to be with her anymore. Dr. Foreman tried to assure her that it was just [[withdrawal]] symptoms. However, Sidas called for help. He said he couldn't feel anything in his legs. Dr. Foreman realized he was unresponsive to stimuli - [[paralysis]].
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[[Image:Dara Sidas.png|thumb|250px|Dara Sidas]]
 
[[Image:Dara Sidas.png|thumb|250px|Dara Sidas]]
Dr. House went to the patient for assistance, but he didn't think he would be able to help. Sidas admitted that twelve years before, he tried to commit [[suicide]] by jumping off an 8 story building into a dumpster. He broke a leg and three [[ribs]]. While he was on [[narcotics]], he realized he wasn't as intelligent and it made him less depressed, isolated and lonely. That's when he met his wife - she was dumb (IQ 87) and happy, and he realized he wanted to stay less intelligent forever. Dr. House felt empathy for the like-minded individual and gave him a bottle of cough syrup, so that "Einstein could give himself a lobotomy". However, he also realized his broken ribs might be relevant. Sidas confirmed he broke the bottom three on his left side, just where his [[spleen]] was.{{Quote|Enjoy|House gives Sidas a bottle of cough medicine}}
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Dr. House went to the patient for assistance, but he didn't think he would be able to help. Sidas admitted that twelve years before, he tried to commit [[suicide]] by jumping off an 8 story building into a dumpster. He broke a leg and three [[ribs]]. While he was on [[narcotics]], he realized he wasn't as intelligent and it made him less depressed, isolated and lonely. That's when he met his wife - she was dumb (IQ 87) and happy, and he realized he wanted to stay less intelligent forever. Dr. House felt empathy for the like-minded individual and gave him a bottle of cough syrup, so that "Einstein could give himself a lobotomy". However, he also realized his broken ribs might be relevant. Sidas confirmed he broke the bottom three on his left side, just where his [[spleen]] was.
   
 
Dr. House planned an [[MRI]] with ferrous oxide [[contrast]] because it would be absorbed by the spleen. However, he realized if the patient had no spleen, the contrast would be absorbed by the liver and would severely damage it. Dr. Chase was incredulous that Dr. House thought he would operate and not remove the spleen. However, when they did the scan, they found several accessory spleens, most likely created when his spleen was damaged by his broken ribs. They realized it was TTP all along, Dr. Chase just didn't remove all of the spleens - there were 16 remaining that had to be removed. Dr. Chase planned more surgery.
 
Dr. House planned an [[MRI]] with ferrous oxide [[contrast]] because it would be absorbed by the spleen. However, he realized if the patient had no spleen, the contrast would be absorbed by the liver and would severely damage it. Dr. Chase was incredulous that Dr. House thought he would operate and not remove the spleen. However, when they did the scan, they found several accessory spleens, most likely created when his spleen was damaged by his broken ribs. They realized it was TTP all along, Dr. Chase just didn't remove all of the spleens - there were 16 remaining that had to be removed. Dr. Chase planned more surgery.
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