Why is this 6 Year Old Going Through Puberty_ _ House M.D. _ MD TV

I thought arthritis was for old people. JRA is an autoimmune disease. Her body is attacking itself, causing inflammation in the joints, her eyes, and her heart. Is it treatable? It can be crippling, but it can also go into complete remission. The good thing is, we caught it early. Gives her the best chance to have a positive outcome. Don't get up, Goosey. Stitches. She's having a stroke. The stroke was caused by a clot in her middle cerebral artery. We started her on TPA. It should dissolve the clot and hopefully prevent brain damage, but we won't know for sure until she regains consciousness. She has another stroke. Arthritis, heart disease. Why can't this kid act her age? JRA doesn't affect the blood. It means the clot's a symptom of something else. A symptom of polycythemia. She's fully hydrated, her blood's still thicker than pancake batter. Thick blood explains a stroke. It can also cause an autoimmune response. We should explain the JRA kicking into gear. But what explains the thick blood? Lack of oxygen forces the body to overproduce red cells. What explains the lack of oxygen? Carbon monoxide fumes, cigarette smoke. Doubt our patient's a smoker. Dad could be. He's not. He says he's not. Hey! Don't make me turn the hose on you two. Chase is right. You two go check the house. See if Dad's a closet Marlboro man. She's being abused. A bloody t-shirt doesn't equal abuse. Kids get hurt all the time. That amount of blood? You two are agreeing again. Father's overwhelmed. Hectic job. His wife passed away last year. He could easily be taking it out on the kids. Or she had a nosebleed and grabbed a t-shirt. She's so ashamed of a nosebleed, she has to hide the evidence in a vent under her bed. She's socially isolated. The brother's always in trouble. It's classic science. No physical signs. No marks on her body. No bruises at all. What if it's sexual? We should call social services. Well, this sucks. Either it's abuse or it's not abuse, which means either it's a symptom or it's completely irrelevant. Either way, we've got to waste half a day figuring out which. Full physical exam. Look for bruises we may have missed. Check her mouth. Do a vaginal exam. We can't do a vaginal exam on a six-year-old without the dad's consent. And if he's abusing her, he'll never say yes. Never. It's just revenue spelled backwards. Have you been abusing your daughter? What? Why would you... We found this. Hidden in a vent under her bed. I don't know anything about this. Maybe she had a bloody nose. We need to examine her for abuse. You can't really think... Maybe you, maybe the school bully, maybe the creepy neighbor. I'm guessing you're not paying as much attention as you should be. You don't even know where your son is right now. Yeah, he was here just a minute ago. She isn't being abused. Fortunately, that answer doesn't help me. If you have abused her, you're obviously going to lie about it. I'm not lying. We need to do a vaginal exam. No. She may be dying. She still can't talk, and you're going to waste your time with this? Either you consent, and we waste a few hours doing the exam, or you refuse, and I call social services, and they waste three days doing an investigation, which ends with them doing the exam anyway. There's cuts all over her genital area, like slices. Some are almost healed, but some are new. She could be doing it to herself. She's a little young to be cutting. She's a little young for a stroke. Depression accounts for the cuts. Molestation accounts for the depression. But do the cuts account for all that blood? They weren't deep enough. So she's getting cut, but that's not the source of the blood? The other obvious source is forcible penetration. The obvious source is the blood, not the cuts. There was no tearing. There's no evidence at all. So we have no explanation for the cuts or the blood. Where is he? What if our original assumption was wrong? Meaning what? We found a T-shirt covered with blood hidden in a heating vein. How do we know it's even hers? Her dad identified it. Not the shirt. The blood. We just tested the blood on Lucy's T-shirt. It's full of endometrial cells. But it's not her blood. We tested that, too. It is. You're a six-year-old patient? It's menstrual blood. She started puberty. She got her period and didn't know what it was. She was scared and confused. A friend told her to put a T-shirt in her underwear. When she started growing pubic hair, she snuck Daddy's razor and tried to shave it off. Apparently forgot to sneak the shaving cream. A tumor's most likely. A pituitary adenoma would send her home on levels sky high. In Puerto Rico in the 70s, there was an epidemic of kids growing breasts because of estrogen in the poultry. If it was in the food, it would be an epidemic. We've got one kid. She's six. She's tiny. She lives on chicken fingers and milk. Dad doesn't look like the type to read labels. He's probably buying stuff packed full of hormones. Excellent argument. It's a tumor. There's all sorts of environmental sources. Pesticides, soy products. Some shampoos are basically a placenta in a bottle. If the tumor's not in her brain, it's in her reproductive tract. Get an MRI. You have feelings for me. You come back to me again and again. For sex, it's a simple physical... Come on, you have feelings for puppies and patients that you barely know. But when it comes to a guy that you've worked with for three years, had sex with, spent the night with, you're telling me you feel nothing? Absolutely nothing? Get away from her! Don't touch her! I'll kill you if you touch her! Get him off! She's biting me! Get him off! Oh! Somebody better be dying. Lucy's big brother's got a crush on me, so he bit the crap out of Chase. And I care because... Just thought you might want to know when one of your employees gets attacked by a sociopath. Bees or monkeys, yes. Sociopaths, no. He's not a sociopath. How do you know? He's acting logically. He's got a crush on you. He's being aggressive about it. Not just regular aggressive. He's out of his mind, out of hormones aggressive. You think he's... Better figure out what's killing the girl, because her brother's got it too. Can I help you? I'm a doctor. Two of your kids are sick, and I need to know why. You think they got sick here? I think you're dating their dad. He told you? I don't really care why he didn't. I just need to know how often you go to their house and what you bring. I don't. Shampoos, fancy soaps, kids get in your bag. I've never been to their house. They just lost their mom. And we thought it was too soon. Why are you staring at me? Lip wax? I just had it done over lunch. Mani-pedi? No. Just the wax. Women get a wax. It's part of a whole self-indulgent beauty ritual. Pedicures, steam, cucumber masks. No one runs out of lunch just to get a lip wax. Unless you woke up looking like Yosemite Sam. You're an ass. It's always the dad. Excess spacial hair in women is a clear sign of hormonal imbalance. Exactly what the little kiddies have. Is there something wrong at the daycare center? There's something wrong in your pants. She's a lot younger than I am. I use a male enhancement cream to keep up with her. What does this have to do with... It never occurred to you to get a prescription except some penis pumper loaded with testosterone. I keep it at the gym. I apply it daily in the shower, just like it says on the bottle. It's never been in my home. It's obviously never been near the kids. But you have. We've been through that. I'm not a pervert or a pedophile. 30% of our waste is excreted through our skin. That sounds high. That's why you stink after eating garlic. Jack waters his beanstalk every day for a week. He's oozing bean curd out of his pores for a month. Every time he gave the little tykes a hug, he gave them a dose of testosterone. Small for you, but more than their little buddies can handle. So... I did this to them? Just holding their hands? Uh-huh. If I stop using it? You'll be floppy. You'll be fine. You'll still be eight.