Let’s get physical! A 30 year old female fitness instructor is shooting an exercise DVD in an outdoor stadium when one of her obese trainees collapses from exhaustion. She helps him up and inspires him to complete the routine, but as the big guy’s having a Rocky moment at the top of the stadium tier his health guru suddenly quits breathing and takes a nose dive down the steel steps. Ah, pure vindication for all us fatties who’ve sweated to the oldies only to drop 30 oz. in water weight! Take that, you skinny bitch!
Cuddy corners House on the Princeton Plainsboro elevator to pass off the new patient file and to announce that she’ll be temporarily moving in with the doctor directly responsible for destroying her office in last week’s standoff. Ahem. House, that’s you. House meets Taub and Kutner on the other side of the room to discuss the new case; Foreman and Thirteen are M.I.A. because it’s the start of the Huntington’s disease clinical trials.
Despite the patient’s breathing problems, a lung CT is normal. Taub thinks she’s too fit not to be a big fat cheater, so he proposes steroid abuse. But Kutner has seen her infomercials and doesn’t believe she’d stray from her own strict program. House is not amused by Kutner’s naїvete and orders him to run the labs anyway. From the office, Cuddy chimes in that the labs are clean and wonders why no one has bothered to read the patient’s file yet. Okay, House has been brilliantly serving PPH for years and we all know he doesn’t use the most orthodox or sensible methods to get the right diagnosis, but the end result is typically what we want to see. McGriddles breakfast sandwiches are incredible but I don’t give two kicks how the geniuses at McDonald’s get those little droplets of syrup in there! I just need to know it’s all good at the end of the day when I take a bite, you hear me, Cuddy? When Kutner suggests car exhaust allergy, Cuddy really jumps in – the patient was jogging ½ mile from the nearest road, but her symptoms could be explained by exercise-induced asthma. House shoots her down because EIA doesn’t explain her elevated blood pressure.
After House, Taub, and Kutner leave the office, we learn that exercise-induced asthma actually does fit because the patient doesn’t even have high BP. House just wanted to shut Cuddy up. The only way to test for EIA is to recreate the same conditions that precipitated the attack, a bit difficult considering the patient’s fall down the stadium steps broke her ankle. But House is sure his boys will think of something. And they do; the next best thing is to have the patient hand-pedal at a vigorous rate on an arm ergometry machine. She relishes the exercise but Taub is still highly skeptical. In the middle of asking her about her fat intake, she suddenly codes and they realize it isn’t asthma.
Thirteen sits in the General Research Center waiting room for the start of the clinical trial. She spies another testee in a more advanced stage of Huntington’s than herself. The sight triggers memories of her mother who also suffered with the disease. During a finger dexterity test with Foreman, she expresses guilt over taking someone else’s spot just because she knows the man running the trial. Foreman tells her to quit whining about perceived nepotism – she needs the trial as much as the next patient because her finger tapping rate indicates her nerves are degenerating.
While House and Cuddy argue over custody of the desk, Taub and Kutner bring the good non-news: despite pulmonary and cardiac arrest, there doesn’t appear to be anything wrong with either the lungs or heart. Kutner suggests a carcinoid tumor, so House sends them off to go find it. During the scan, Kutner asks for Taub’s expert medical opinion on another patient: can leaking breast implants cause joint pain? Wait, what other patient? Apparently, Kutner thinks it’s a brilliant money-making idea to set up an online second opinion clinic under House’s name. Actually, it is a pretty good idea, minus stealing House’s identity. Taub’s greedy plastic surgeon comes out to play and he threatens to snitch unless he gets in on the action at 30% of the profits. That’s blackmail, Kutner (you idiot). Taub studies their current patient’s scan and does a double-take: her stomach is the size of a shot glass. The big fat cheater is now more fit than fat due to gastric bypass surgery.
Kutner tells House that Big Fit Cheater’s prior obesity could’ve caused her to have type II diabetes leading to permanent nerve damage, but House tells him the symptoms would’ve kicked in years ago. Then he interrupts the differential to annoy Cuddy, but she’s got his number (and his balls…his thinking balls, the ones he bounces against the wall to help him think…yeah, and the other ones too). Kutner brings him back to the case by suggesting sleep apnea and House refutes that too because apnea would’ve resolved itself once she lost the weight. But Taub agrees with Kutner that it could still be the problem if prior apnea destroyed the musculature of her trachea.
House isn’t satisfied working the case with just Taub and Kutner, so he decides they should bring the party to Foreman and Thirteen in the middle of her treatment. With an IV in her arm, Thirteen suggests potassium mal-absorption as a byproduct of the bypass and Kutner points out a blind loop of bowel could be a natural off-shoot of this condition – if it ulcerated during exercise, bacteria could’ve flooded the bloodstream and infected her heart and lungs. House orders a stool sample to check for small intestinal bowel overgrowth (SIBO).
Taub can’t hide his distaste for Big Fit Cheater when requesting her poop, so she feels the need to defend her dishonest decision to him. Look, I’m no snob when it comes to health and wellness. You can do it the right way or the way that’s right for you, so long as you’re not popping pills or sticking a finger down your throat. But when you get your stomach stapled for vanity’s sake and then decide to preach healthy eating and exercise for a living? Well, that’s just wrong.
Wilson confronts Cuddy about her decision to take over House’s office space. It’s obviously a major flirtation on her part and a way to stay close to her boo. He tells her to quit the denial. She denies the denial and kicks him out of her/House’s/their office.
Kutner tells Taub that he received another e-mail from “the boob lady,” who’s now experiencing chronic fatigue. She’s threatening to complain to the licensing board if “House” doesn’t find out what’s wrong. Kutner’s screwed and Taub thinks it’s hilarious. The real House enters the lab to hear the results of Big Fit Cheater’s stool screen, but they have one more hour to wait. In the meantime, House asks for a guess on what they should be looking for. Taub says that if it is, in fact, SIBO, they should see a high fat content in the waste. And if there’s a lot of fat in the stool, it should float in water. House pulls on an industrial-grade rubber glove and fills a beaker with water. He plops a piece of poop into the beaker and it promptly sinks to the bottom. He regrets dismissing apnea so quickly and instructs Taub and Kutner to observe BFC overnight in the sleep lab.
Instead of watching Big Fit Cheater sleep, Taub and Kutner pore over CT scans for The Boob Lady. Could it be scar tissue encapsulation of the implants? Nah, that’s normal. She just needs to get a proper surgeon to correct the placement. Maybe it’s just a virus. Yeah, tell her that and it ought to appease her enough to… Whoa, BFC’s EEG just flatlined. Wait a sec, where is she? Taub and Kutner find her in another room jogging on a treadmill. She claims not to be in any pain from her broken ankle. Taub looks down and notices that her leg is bleeding from friction between her skin and the cast. He pricks her and determines that she can hardly feel anything at all. Ascending numbness indicates neural breakdown or brain degeneration. Or both.
House and the entire team return to the office to continue the differential, but the room stinks like rotten eggs. Cuddy plays dirty and spills a batch of hydrogen sulfide all over the place. They gag and evacuate to the hallway. Foreman’s pager goes off telling him it’s time he and Thirteen return to treatment. She insists on staying to continue the diagnosis; she contributes multiple sclerosis as a possible culprit for BFC’s problems. Kutner thinks early onset Parkinson’s disease is another strong contender, and Taub suggests transverse myelitis (a neurological disorder caused by inflammation of the spinal cord). House tells them to run a nerve conduction velocity (NCV) test to measure the amount of time it takes for electrical impulses to travel along her nerves.
During the NCV test, Big Fit Cheater confesses to Taub that she does feel like a hypocrite. But she claims she didn’t get the bypass to lose weight for DVD sales. She just wanted to help people. Taub notices her arm is shaking and he realizes the problem isn’t with her nerves; it’s her muscles.
Foreman can’t find Thirteen, so he breaks into her apartment to unearth why she isn’t taking the trial seriously. Instead of finding a reason to boot her out of the program, he discovers only proof that she’s following his instructions more strictly than any other patient. So, what’s up? When she gets home, Thirteen explains that the advanced Huntington’s patient she keeps seeing is a constant reminder of where she’ll be in 8 to10 years. Foreman tells her that although it’s understandable to feel the way she does, she needs to get over it. He gives her one last ultimatum that sets off another flashback: young Thirteen sitting in her room as her father bangs on her door, telling her to come say bye to her mother or she’ll regret it the rest of her life.
On the elevator, Taub and Kutner bump into a heavily tattooed blonde with pain, fatigue, excessive hair loss, and fake tits… Uh-oh! It’s The Boob Lady! They trick her into returning downstairs and checking into the ER. They treat her for a staph infection with massive antibiotics and return upstairs to House. Taub tells him Big Fit Cheater has myasthenia gravis (an autoimmune disorder characterized by muscle weakness), but House says no way – BFC’s breathing is improving and the weakness is in her extremities alone. Kutner thinks it could be botulism poisoning due to an overdose of Botox to tighten up loose skin after rapid weight loss. House says the way to treat that or any number of other toxins is through chelation. Then he smashes Cuddy’s office toilet with a sledgehammer – tit for tat, one stink deserves another.
The team pow-wows in the hospital stairwell after the chelation fails and they discover BFC’s muscles are continuing to deteriorate; they can’t meet in the office because not only does it stink but it has no furniture – Cuddy got rid of their tables and chairs in response to her busted commode. Thirteen suggests a heart defect and Foreman proposes Austrian Syndrome (an alcohol-induced disorder that causes pneumonia, meningitis, and heart failure), but neither diagnosis can hide the tension between the pair. Since the problems started with BFC’s lungs and not her heart, and the patient is a teetotaling health nut, neither diagnosis fits. Taub thinks of Guillain-Barré Syndrome (a temporary inflammation of the nerves). Both his and Kutner’s pagers go off. House is suspicious but lets it go. He agrees that Guillain-Barré makes sense and orders them to begin plasmapheresis (blood plasma filtration).
The Two Stooges rush to the ER where The Boob Lady is rocking back-and-forth and repetitively singing, “Put the Lime in the Coconut” in a really, really creepy way. Kutner believes she’s faking it but Cameron pulls back the patient’s hair to reveal she’s bleeding from one ear. Kutner meets later with Cameron and Chase to discuss The Boob Lady’s condition. It might be an aneurysm and Kutner thinks he can manage it with a calcium channel blocker. Chase recommends he just tell House, but Kutner refuses. He’s got to keep trying on his own. Wilson’s disease. Anorexia. A biliary tumor causing paraneoplastic syndrome. That last one might work. Chase offers to scan her…for a 25% piece of the pie.
When Taub tells Big Fit Cheater about the Guillain-Barré, she starts to feel sorry for herself. Taub won’t let her wallow and motivates her to get out of bed and walk with him to treatment. Later, she hallucinates a visit from all of her overweight clients who angrily bury her in two tons of fun. She leaps up screaming and barely able to breathe.
House divulges his plan to disturb Cuddy’s office renovations to Wilson who makes an excellent point: won’t that just mean more time with the woman you claim you want to get away from? Stop pulling her pigtails and ask her out already!
Hallucinations knock out Guillain-Barré but show that Big Fit Cheater’s brain is deteriorating. Thirteen suggests central nervous system (CNS) lymphoma and Taub proposes prion disease (a progressive degenerative illness of the brain). House orders a brain biopsy, but Cuddy overhears and overrules him – they need to test for and rule out other conditions before cutting her head open. House confronts Cuddy after Taub and Kutner leave to perform the tests. He accuses her of butting in because she has the hots for him. She accuses him right back of digging on her too. They get closer and closer until Cuddy, practically pressed up against his chest, begs him to surrender to passion. His reaction is classic House perfection: he forgoes the anticlimactic second kiss for a boob snatch. Cuddy is disappointed but I’m not.
Thirteen returns to the GRC for the trial. She spots the other Huntington’s patient sitting in the waiting room and struggling to put on her sweater through violent body jerks. She asks Foreman if she can change her appointment time to avoid her but he refuses. Another flashback: a view from her bedroom window of her mother struggling into the passenger side of the family station wagon; her father beckons her down to them but she doesn’t go. Thirteen walks over to the other Huntington’s patient and gently helps her get dressed.
As he wheels Big Fit Cheater down the hallway, Taub tells her that her head MRI revealed no CNS lymphoma. BFC asks for chocolate cake. He warns her against giving up on herself but gives her dessert anyway. Taub goes to House to inform him they’ll need to get permission from Cuddy for the brain biopsy because the patient’s getting worse. They go to her room and find her looking and feeling much better. Well, I always said sweets cured all my ills. BFC has hereditary coproporphyria, a genetic enzyme deficiency. Treatment is bypass reversal and a high-carb, glucose-enriched diet, meaning that her days as a super-fattie were actually the healthiest she’d ever been; she was self-medicating with Ding Dongs and Häagen Dazs. Gaining weight terrifies BFC so much she refuses the new diet in place of maintenance medication for the rest of her life.
Taub and Kutner go to the ER to check on The Boob Lady and find an empty bed, but she hasn’t been discharged. She’s dead! They go down to the morgue to view her body and figure out how the hell they’re going to save their careers. House finds them and demands to know why they didn’t come to him before it was too late. But maybe it’s not too late. House jumps on the table and begins chest compressions. The “corpse” springs to life and The Two Stooges almost pee themselves. The Boob Lady was just an actress House hired to teach them a lesson after he first learned of the website. He requests 50% of the site’s profits for letting them use his name.
Thirteen finally admits to Foreman that the other Huntington’s patient didn’t force her to confront her future, but instead brought her back to her past. She tells him that her mother’s illness caused her to cry out and scream uncontrollably in front of her friends which confused, embarrassed, and angered her as a child. Thirteen wanted her mother to die and her hatred prevented her from saying goodbye.
Cuddy returns to her newly renovated office, relieved to be away from House. She tells Wilson that she’s finally over him and can move on. Then she notices her new desk. It’s actually an old desk, one she used in med school that her mother’s been keeping in storage. But mom didn’t know she was re-doing her office. Who else would know to…? She happily skips over to House’s office to thank him for the gift and jump his bones. Instead, she finds him flirting with The Boob Lady. Oooh, rejected!
Next Week: A very special (and miserable) Christmas episode.
