- House, I'm challenging you
to not flinch during my reaction video.
Pewoop!
- Still drawing those lines,
instead of looking at the cards.
(Adam moaning)
(cup clanking)
- More juice?
- If he wants more juice, he has to ask for it.
(Adam choking)
- He's choking.
- Time to institute the Heimlich maneuver
and stop bullying your child.
- It's impossible, it's mac and cheese.
- What do you mean it's impossible?
What, is mac and cheese unchokable?
(Adam screaming)
All right, the fact that he's yelling
though, makes it a little bit less likely
that he's actually choking.
If you're yelling, that means you're moving air.
- 10-year-old boy, screams for his life for no reason.
- He's autistic, severely autistic.
- Okay, so a child with autism,
what we have is an Autism Spectrum Disorder.
And, we don't know where
in that spectrum, this child lies.
- [Foreman] Can't talk, can't make eye contact.
Screaming's probably his way of communicating.
- Yeah, you know, some children
that have been diagnosed with autism, one of the challenges
that they face is verbal and non-verbal communication.
But, some children don't have good social cue identification
where they can't understand someone's emotion
by reading their body language,
or they can't speak themselves
or they choose not to speak themselves.
- His brain can't filter information.
It's a constant assault on his senses.
I'd, scream too.
- One of the main things that go hand-in-hand
with ASD, hypersensitivity, sometimes
to light, touch, sound.
And remember, while we're only naming the challenges,
there are some positives that can come
from a diagnosis of ASD.
Some children are super smart, some have the ability
to memorize things way better than the average child.
So, it's not only about the challenges,
it's about the strengths too.
- ER checked his throat, no obstructions, nothing,
which means the only symptom was a scream,
which is diagnostic of nothing.
- I completely agree with Foreman.
You have a child who is diagnosed with autism,
who started screaming,
and the parents are very worried about it.
And now, they're doing this giant workup
with multiple specialists.
I wouldn't even know what the consultation would ask
of the specialist.
- A stool sample to check for parasites, blood culture
to rule out infection, and ANA for lupus.
- Because he screamed?
- I love investigating,
if there is an investigation warranted.
You're checking for ova and parasites and lupus?
You can't order tests willy-nilly
because false positives are really a thing.
- Dust, wheat, pollen, a toxin, or something-
- It could literally be anything!
'Cause right now, your one symptom is screaming.
- Run a lung ventilation scan.
Lungs are in the chest too, right?
- I had a date last night, she screamed.
Should we spend $100,000 testing her?
- Why did your date scream?
That was a weird revelation.
- Of course not, this isn't a veterinary hospital, zing!
- Actually, the veterinary hospital thing is kind
of funny to me, because in medicine we oftentimes say,
treating kids, working
in pediatrics, is a lot like being a vet.
Because, sometimes the children,
if they're really young, can't tell you what's wrong
with them, so it's almost like treating a dog
who can't tell you what's wrong with them either.
- You know what it's gonna be like
trying to put an autistic kid into a nuclear scanner?
I don't envy you guys.
- In those cases, we do sedate.
We give medications like benzodiazepines
for temporary sedation.
(Adam screaming)
- [Mother] Can't you sedate him or something?
- I could if I don't want the test results
to mean anything.
- Are they doing a CT?
If they're doing a CT, you could sedate the child.
I don't know why you said
that the test won't mean anything.
God, did they just break
into people's homes all the time?
- Big shocker, dad's depressed.
- And they're, getting information on the parents!
This is so unethical.
This workup on a screaming child is gonna cost $10 million.
They're gonna test his sand out of his sandbox!
Who's paying for this?
I can't get insurers
to pay for an antibiotic if it comes
in an easy-to-swallow capsule,
and they're gonna get insurance
to pay for sand testing, shamone!
- Fecal matter, is there a sample we can look at?
- Parents have the smear kit, the kid is constipated.
- Go up his rear and get a smear.
- Talk about creating a traumatic situation
for a child for absolutely zero reason at this time.
But somehow, 'cause it's a House M.D. episode,
he's gonna be right.
I don't even know what they're looking for in this sphere.
They already got an ova and parasite sample.
(Adam retching)
- [Father] Adam?
- Adam?
Adam?
(Adam retching)
- So, what makes fluid fill the lining of the kid's lungs?
- Infection, tumor (chuckles).
I feel like I'm one of his students just yelling stuff out.
- If there's a pleural effusion, we have
to rule out heart failure.
The pleura, by the way, is the lining
that covers the lungs.
Organs are covered by pleural membranes,
which essentially prevents the organs
from rubbing all over each other.
So, there's a cardiac membrane, there's a lung membrane.
- [House] Get the kid an echocardiogram.
(Adam screaming)
- Adam?
- Very hard to perform an echo as is,
but to perform one on a uncooperative patient
or a combative patient, even harder.
(Adam grunting)
- What?
What is it, is his heart okay?
- No.
Echo suggested a conduction abnormality, EKG confirmed it.
- A conduction abnormality is basically
when there's a problem
with electrical conductivity of the heart.
So basically, in one part of your heart you have a node
that starts your cardiac rhythm.
And then, it travels throughout the rest of the heart.
The reason it has to travel
throughout this conductive system, is
because you don't want
the entire heart, beating simultaneously.
Otherwise, it's gonna have all the blood just splat
against each other.
But, if you have the top of the heart beat first
and then the bottom of the heart beats,
then you can have a rhythmical pulsation of the blood
throughout the heart.
- Get a lung biopsy.
- What, it took a half an hour
to get the mask on the kid for the lung scan!
- Oh, I'm sorry, was there somewhere you needed to be?
- What are they gonna do, a bronchoscopy?
I don't understand how they're gonna do a lung biopsy,
like interventional radiology?
What part of the lung are they gonna test?
This makes no sense, this is brutal.
- We wanna do a lung biopsy.
- Lung biopsies usually come back negative.
So, biopsy a lymph node under the arm.
(Adam screaming)
- Why are they against sedating this poor child?
Sedate, please, it will not change your biopsy results.
And, the child will not be further traumatized
by this medical experience.
- Hope is what's making it miserable.
What they should do, is get a Cocker Spaniel.
Dog would look him in the eye, wag his tail
when he's happy.
- Animal therapy for children
with autism can actually be quite beneficial.
There's less judgment that comes
from animals, almost no judgment, actually.
The interaction that you could have
with the animal is so much simpler.
That is an easier introduction to human interaction,
which is much more complex.
Horses, dogs, that kind of thing,
supportive animals really go a long way
for children who have autism.
Not for all, but in some cases.
- No cancer, because these aren't lymph cells.
- Then, what are they?
- Okay, let me try and guess.
These aren't lymph cells, so what did he get a biopsy of?
A huge sweat gland, an abscess, a dermatofibroma?
Oh my God, what could have he gotten?
Oh, oh a teratoma, that has hair cells
in, ah, I can't, I have no idea.
- Liver cells?
- Does he have liver cancer that has metastasized
to his armpit?
- What's the difference between cancer cells
and liver cells?
Why can one pass through walls, but the other can't?
- Cancer cells are damaged, lets them grow
into blood vessels, go wherever they want.
- So, if the liver cells are damaged...
- Liver isn't damaged, the tests were normal.
- Well, tests on a liver being normal,
doesn't necessarily mean the liver is normal.
Because, the tests that we use to check liver function
which we call liver function tests,
it's actually a misnomer.
They're actually liver inflammation tests
that tell us if the liver is damaged,
thereby releasing liver enzymes.
And, if these liver enzymes are elevated
that we know there's a problem with the liver.
However, if your liver is so diseased
that it's in the end-stage of liver cancer,
cirrhosis, those numbers can be normal
because your liver is almost fried
and there's no enzymes left to be had.
- It's not his liver, his heart or his lungs.
It's the calcium carbonating in his stool.
- Kid was constipated, parents probably just overdid it.
- Maybe, he ate a bunch of chalk, or Tums.
- Or they didn't do it at all.
Calcium carbonate's also what's in chalk.
- Oh!
- So, he ate some chalk, it isn't toxic.
Sure it didn't cause a pleural effusion.
- Forget the chalk, this kid's got pica.
Take him into a buffet, he's gonna eat the table.
- Pica, it's a condition where, you start eating things
that are not edible, paint off of the walls, mud.
- Show me what you ate.
(Adam groaning)
- Adam?
- Honey?
Adam?
- I don't know what that was, some kind of sand fly
or sand weasel inside of that sand.
- It's a micro tumor, started in his lung
which caused a pleural effusion.
Then it metastasized to his liver
which made it slough cells.
- No, it has to be some kind of worm traveling
throughout his body.
(light instrumental music)
- Hey, kill the lights.
He's seeing them all the time.
- What are you looking for?
- He's telling us what he was seeing,
telling us exactly what was wrong
with him, drawing them for us over and over again.
Hello my pretties.
- Nematodes!
- [House] It's not a tumor Foreman, it's worms.
- Aha, we said worm!
We also said everything else.
So, I'm not gonna even take credit for it.
- Animal makes potty in the sandbox,
boy plays in the sandbox, boy eats the sand,
you can probably tell where this is going by now.
- The stool samples were negative for parasites.
- Raccoon roundworms are not excreted
by their human host.
- Cameron tested.
- Bro, stop acting like you knew
about raccoon poop without looking it up, I swear!
- Worms spread from his gut
to the rest of his body, attacked his lungs,
that's what made him scream-
- I don't even care that he knew it was raccoon poop.
It's the fact that he knew humans don't release it
in their own fecal matter.
If that information ever becomes useful
to me for some weird way, I'm gonna send a thank you letter
to the writers of the show.
- They attack his eye and the muscles surrounding it,
making his eyeball do a backflip.
Laser photocoagulation to fix the eye
and a high dose of benzimidazole to kill the worms.
- Just think about the sequence of events here.
Child, that's diagnosed with autism comes in screaming
into the ER, House immediately starts running tests
on him and finally gets down to it,
that he ate raccoon poop from a sandbox.
How did we get here?
I had a unique patient case myself.
Click here for that full story.
Doctors kept misdiagnosing this gentleman,
see what happens here, click.
As always, stay happy and healthy, but click.
(upbeat music)