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John Henry Giles

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== Case History ==
 
== Case History ==
   
The patient was admitted after he had difficulty [[breathing]] after exerting himself during a recording session. He was diagnosed with lobar [[pneumonia]], but Dr. House learned about the case and was wondering why the patient was paralyzed. However, at the request of the patient's primary care physician, Dr. [[Marty Hamilton]], the case was assigned to the remainder of Dr. House's team by [[Lisa Cuddy|Dr. Cuddy]]. The patient was on an experimental treatment protocol for the [[paralysis]] and Dr. Cuddy believed [[Eric Foreman|Dr. Foreman]], who had done his [[Resident|residency]] with Dr. Hamilton, would be more likely to respect the wishes of the primary care physician. Dr. Foreman was assigned as [[attending]].
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The patient was admitted after he had difficulty [[breathing]] after exerting himself during a recording session. He was diagnosed with lumbar [[pneumonia]], but Dr. House learned about the case and was wondering why the patient was paralyzed. However, at the request of the patient's primary care physician, Dr. [[Marty Hamilton]], the case was assigned to the remainder of Dr. House's team by [[Lisa Cuddy|Dr. Cuddy]]. The patient was on an experimental treatment protocol for the [[paralysis]] and Dr. Cuddy believed [[Eric Foreman|Dr. Foreman]], who had done his [[Resident|residency]] with Dr. Hamilton, would be more likely to respect the wishes of the primary care physician. Dr. Foreman was assigned as [[attending]].
   
 
The patient's [[oxygen|O2]] count was remaining in the 90% level, and he was not coughing up [[sputem]]. He appeared to be in stable condition. Dr. Foreman ordered that his antibiotics be continued. However, he was worried about [[sepsis]] and ordered tests of [[thyroid]] and [[adrenal gland]] function. Dr. House asked what Dr. Foreman was doing about the paralysis, and Dr. Foreman replied he was sticking to the treatment protocol as the patient had already been diagnosed with [[ALS]] by Dr. Hamilton. However, Dr. House noted that ALS is a diagnosis of exclusion as there is no test or treatment for it. Dr. Foreman replied that Dr. Hamilton had already ruled out any other possible cause for the paralysis. Nevertheless, Dr. House started a new differential for the paralysis. [[Robert Chase|Dr. Chase]] suggested [[Guillain-Barre syndrome]], which is treatable. However, Dr. Foreman pointed out that in Guillaine-Barre, the progression of the paralysis is always symmetrical, and it was not in the patient's case. [[Allison Cameron|Dr. Cameron]] suggested [[transverse myelitis]], but Dr. Hamilton had tested the patient for it and the test was negative. There were also no masses and his [[AVN]] was normal. Dr. Chase suggested an [[autoimmune]] condition attacking the patient's [[nerves]] - [[multifocal motor neuropathy]]. Dr. House noted that this fit the patient's symptoms, even though the condition is rare. He asked if Dr. Hamilton had ever put the patient on [[intravenous]] [[immunoglobulin]]. Dr. Foreman replied that this had not been tried and Dr. House ordered an [[MRI]]. However, Dr. Foreman overruled him. Dr. Foreman noted again that ALS fit the symptoms and would also explain the pneumonia. Although Dr. House pointed out that ALS was a terminal diagnosis, Dr. Foreman pointed out that just because it was terminal didn't make it wrong.
 
The patient's [[oxygen|O2]] count was remaining in the 90% level, and he was not coughing up [[sputem]]. He appeared to be in stable condition. Dr. Foreman ordered that his antibiotics be continued. However, he was worried about [[sepsis]] and ordered tests of [[thyroid]] and [[adrenal gland]] function. Dr. House asked what Dr. Foreman was doing about the paralysis, and Dr. Foreman replied he was sticking to the treatment protocol as the patient had already been diagnosed with [[ALS]] by Dr. Hamilton. However, Dr. House noted that ALS is a diagnosis of exclusion as there is no test or treatment for it. Dr. Foreman replied that Dr. Hamilton had already ruled out any other possible cause for the paralysis. Nevertheless, Dr. House started a new differential for the paralysis. [[Robert Chase|Dr. Chase]] suggested [[Guillain-Barre syndrome]], which is treatable. However, Dr. Foreman pointed out that in Guillaine-Barre, the progression of the paralysis is always symmetrical, and it was not in the patient's case. [[Allison Cameron|Dr. Cameron]] suggested [[transverse myelitis]], but Dr. Hamilton had tested the patient for it and the test was negative. There were also no masses and his [[AVN]] was normal. Dr. Chase suggested an [[autoimmune]] condition attacking the patient's [[nerves]] - [[multifocal motor neuropathy]]. Dr. House noted that this fit the patient's symptoms, even though the condition is rare. He asked if Dr. Hamilton had ever put the patient on [[intravenous]] [[immunoglobulin]]. Dr. Foreman replied that this had not been tried and Dr. House ordered an [[MRI]]. However, Dr. Foreman overruled him. Dr. Foreman noted again that ALS fit the symptoms and would also explain the pneumonia. Although Dr. House pointed out that ALS was a terminal diagnosis, Dr. Foreman pointed out that just because it was terminal didn't make it wrong.
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