Health and Psychology

"When you hear hoofbeats think horses, not zebras", which was coined in a slightly modified form in the late 1940s by Dr. Theodore Woodward, a former professor at the University of Maryland School of Medicine in Baltimore. Since horses are the most commonly encountered hoofed animal and zebras are very rare, logically you could confidently guess that the animal making the hoofbeats is probably a horse.

However zebras exist.  Every episode of "House" has one.  So how do you know how much of a zebra you are medically?  To answer this question I've created the Zebra Scale.

The Zebra Scale

0--You are a horse.  You have a cold or a flu.  You have a diagnosis.  It's not rare.  There's no clinical trial or orphan drug associated with it.  You can live with it.  You may be able to recover completely.  If you spell it correctly you'll have thousands of internet hits on any search engine.  If there is a treatment it's probably already in a generic version.  Any decent physician can diagnose it.  It's a condition ruled out in the first 2 minutes of a "House" episode.

1--You are a Wanna Be Zebra.  You have a common medical condition some MDs failed to diagnose in several visits.  It's like Hasimotos Thyroiditis or Multiple Sclerosis.  There are some treatments (they may not be great but they exist).  There are even support groups.  There may be large organizations devoted to your illness.

2--You are a baby Zebra.  You have an uncommon illness.  It may have taken weeks or months or even a few years to diagnose.  They may have a clinical trial going on for treatment options.  Your primary care physician is checking with his or her malpractice carrier and buying medical books and signing up for continuing education classes in this area.  You have not lost your faith in medicine.  Your illnes has a name.

3 --you are a fledgling Zebra.  You have a rare illness.  It's taken more than a year to pin down a diagnosis and you've seen 6 physicians or more.  There are treatment options, but none of your physicians have ever seen a case like yours before.  It's really speculative what might work.   Doctors are willing to work with you but they are starting to call in specialists.  Doctors are getting the "look of dread" when you come in.  Not all their office staff knows you.  You haven't yet maxed out your insurance.

4--You are an adult Zebra.  You have a rare illness.  You've been kicked out of at least one doctor's office.  Treatment options are limited.   You are seeking out alternative and complementary medicine providers because seeing another specialist will just leave you in tears or punching holes in walls.

5--You are a mature Zebra.  You have at least one rare illness or a combination of illness such that treating one illness exaccerbates the other illness.  You have either a back office number to your physician, their answering service and all office staff knows you by your first name, or you have your physician's home phone number.  Your physician may make house calls.

6--You are the Zebra that the doctor listens to and just says "wow."  You have failed all conventional treatments to date.  Your doctor hates you and has been sending you to "specialists" so they can try to feel better about themselves.  They cut the visits short.  They leave the clinic for "lunch" immediately before you are scheduled to be seen.  You fare no better with the specialists.  At least one doctor has said "there is nothing more I can do for you."

7--You are the Zebra squared.  You have more than one Zebra illness.  You come from a gene puddle not a gene pool.  Treating one illness no one has ever heard of, triggers another illness no one has ever heard of.  You may have extra or missing organs.  You can personally read an x-ray and all your labs.  You are brushing up on foreign languages just in case someone somewhere has this combination of conditions. 

8--You are the research Zebra.  You are in the process of scouring the internet for every clinical trial, complementary medicine technique, and have a rewards card from Vitamin Barn.  You have started an herb garden, cut out gluten, been on a food rotation diet, and have multiple 7 day a week pill containers to contain all the pills and supplements you are trying.  You've pretty much given up on conventional medicine and are researching everything else.  You've been spotted wearing sunglasses at night covered in zinc oxide "just in case."  You filter your own water and are growing your own food hydroponically. 

9--You are the travel Zebra.  You have gone to a research hospital in search of a diagnosis or a treatment.  You are being referred to the National Institutes of Health, the Mayo Clinic, the City of Hope, or you're being referred to a "large university" with a research staff.

10--You are a special Zebra.  An illness is named after you.  You've been part of an NIH study on your illness.  There is no available treatment.  You are talking to researchers across the country.  You are looking inito molecular biology laboratories you can "converse with."  You are thinking of having offspring to harvest their stem cells.  You are thinking about getting a PhD in medicine.