Monday, 11 February 2013

Horses vs. zebras

If  you were to hear hoofbeats approaching, what would be the first think you'd think of?  Like the vast majority of people, you'd probably think of horses, right?  Of course you would, because that what all rational, sane people would do.  I think of horses also, but I also think of zebras.  Why zebras?  A zebra looks like a horse, its hoofbeats sound like a horse, hell it may even smell like a horse, but it is definitely NOT a horse.  This is the way surgeons learn to think, because just when we think the diagnosis will be something simple and common (a horse!), it turns out to be something completely unexpected.

The ER doctor called for a young woman in her 20's with abdominal pain.  That's certainly common enough - in young people with abdominal pain, my mind automatically goes straight to the horse - the appendix.  "Her pain is all over," he continued, "but mainly in the upper abdomen."  Ok, the appendix is in the lower right part of the abdomen, so it probably wasn't the appendix.  Fine, upper abdominal pain in a woman - it must be her gall bladder.  Another horse!  I prepared myself to ask about liver function and prior surgeries.

"...and mainly in the left upper abdomen."

Uh...the gall bladder is in the upper right, so that's strike two.  There really aren't too many things which cause pain in the left upper abdomen.  The spleen is up there somewhere, but splenic pain is very uncommon.  Now my mind started thinking about zebras.

The next step was to obtain a CT scan, and as I looked at the images, it became clear that this was definitely NOT a horse.  There was something in her stomach that was causing an obstruction.  Was it a tumour?  Whatever it was, the thing was so big it wasn't allowing the stomach to empty.  She needed urgent surgery, so that's exactly what she got.

In the OR, that thing causing the obstruction was not a tumour.  It was...a big hairball.  Yes, a hairball, one that extended about 30 cm (12 inches) down her GI tract.

After surgery, she was questioned about her, um, eating habits.  It turns out that she spent her free time watching TV and eating her wig.  Yes, you read that right - eating her wig.  And it was also discovered that this wasn't the first time this had happened.  Several years before she had had a big ball of cotton removed from her stomach after she had eaten a towel that she had meticulously shredded.

I'm not sure if there is anything more exotic than a zebra that makes the sound of hoofbeats, but I guarantee you if there is, I'll find it.  Because whatever that strange creature is, that is what this case was.

17 comments:

  1. This is something straight out of "My Strange Addiction".

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    1. I jut realized it sounds like I'm accusing you of ripping the story off of the show. My bad.

      This *sounds like something straight out of "My Strange Addiction".

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    2. I would be concerned if the story weren't true. No worries.

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    3. Are your stories ever not true? I'd assume they are occasionally exaggerated to some extent, but that's Farley natural in writing.

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    4. Farely* damn autocorrect.

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    5. SkyGuy32 - They are all absolutely true. Certain details may be slightly altered to protect the subjects, but that's it.

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    6. Thanks, Martial. Couldn't quite get that down.

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  2. I've always been different, maybe even weird, compared to my family. But compared to strangers, holy cow, what the heck is wrong with them? Sadly, I don't think this woman will change her ways.

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  3. I wonder what she'll eat next!

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  4. She sounds like she needs some kind of psychological help! I've no idea whether that type of compulsion can be addressed but if she carries on then she's going to do herself a serious mischief.

    Hope you're not pulling a ball of tangled wire out from her by Christmas doc'.

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    1. PS I'm sure we're getting a backlog of FML pictures to hear about - what's with the scan that looks like a pair of safety goggles?

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    2. It's a CT scan of a patient of mine who was shot in the chest. The story isn't that interesting, but I liked the picture.

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  5. I seem to always get zebras if I have to go to the hospital or doctor, especially when my colon shut down, I had so many tests that all would come back normal, usually that's a good thing, but it was so aggravating because I knew something wasn't normal, I was so happy when they finally figured it out!

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  6. EDS (Ehler's-Danlos Syndrome) patients have taken the zebra as their "mascot" for precisely the reason that you outline in the first paragraph. There's this whole constellation of symptoms associated with this connective tissue disease, and when the doctors look at the symptoms they think "horse". Logical enough, except that it's NOT a horse, it's a zebra, and it's damn hard getting the doctors to accept that.

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  7. Very belated and I'm neither doctor nor psychiatrist, but maybe this young lady had pica? That certainly would explain her eating odd substances like hair and cotton.

    Or, maybe she's just weird and likes eating odd things - when I was in second grade (primary school for those of you across the pond - seriously why that name? Primary school? Secondary school? Why not call college Supernumerary School at that point?) I would chop up certain kinds of eraser into tiny pieces with my fingernails and eat the eraser bits. There was no real reason, it wasn't a nervous tic, I just liked the way they felt in my mouth. And it had to be a specific kind of eraser too - it couldn't be the ones that left huge rubbings on the end or were really friable, they had to be ones that were a little closer to art erasers and erased clean. Thankfully the bits were small enough I never had trouble, and I grew out of it sometime by the fourth grade.

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