This is so true, probably for most of us. And really, it's probably the right thing to do if we can take our emotion out of it for a second. Start with the most plausible diagnosis and work from there. Otherwise, you could miss the obvious.

But yeah for me, I had a very zebra experience:

Complaining of a high heart rate and feeling like I'm having a hard time catching my breath- well you must be anxious said the nurse practioner.

I was having a cronic upper back ache- you must have pulled a muscle said the nurse practioner.

Gigantic red thing crawling from my calf up to my thigh- it's probably phlebitis said three different doctors; one even said I should just go to the gym and work through the pain (I'm never letting my outrage over that one go).

The EMT thought I was having a panic attack. Kept telling me to push out a breath, as hard as I can. Are you freakin' kidding me??? I can't get breath in let alone push it out. Felt like I was drowning. My horse started morphing into a zebra as soon as JoJo the EMT circus chimp couldn't fine a blood pressure. That's when things finally took a turn and I was loaded into an ambulance.

I'm so thanful for the ER doc. Seriously, within 10 seconds, he surmized I had a DVT and blood clots, started me on heparin before my CT scan, just in case. Dude saved my life.

Diognosed with zebraitis a year ago tomorrow !

It took them 24 hours to come up with the answer, they even brought some students over to see me as I was a very strange case. Was firstly diognosed with pneumonia then every thing got worse until I was thrombolised.

After I was released 10 days later the pain became unbarable in my lungs and back so went to the docs who gave me anti anxiety pills and antidepressants. The pain became so much that I ended up in hospital with... pneumonia

I learnt that I dont realy trust doctors, I have more respect for the nurses and ultrasound technicians that see these problems daily, the brains of the country's healthcare

The horse-zebra thing is a bit like the classic Occam's Razor. When there are competing possibilities to explain a phenomenon, go with the one that is simplest and that introduces as few variables as possible.
http://en.wikipedia.org/wiki/Occam's_razor
The unfortunate thing is that venous thrombotic events have always been more common than is generally believed, with even the surgeon general's call to action to prevent dvt/pe citing best estimates of 350,000 to 600,000 victims per year, and 100,000 deaths. The horses have always been around. They were just mistakenly called zebras.

Yeah, I was thinking Occam's Razor too. The thing is, symptoms of a PE are symptoms of so many other things. When I started experiencing PE symptoms, I did even have symptoms of a DVT. The DVT presented itself later. So, there was no dots to connect when I started having shortness of breath. However, once I had the classic symptoms of a DVT, you'd think one of the three doctors I saw would have picked up on it. Ugh.

It's not that I don't trust doctors. It's that I trust myself more.

I was lucky, my PA saw a horse but wanted to check it for stripes, just to be on the safe side.

I can't thank him enough.

*flips over to Wikipedia and reads a bit*

Yes, the zebra/horse does seem to be a slightly more visual statement of the Occam's Razor theory. I feel so philosophically educated all of a sudden!

I think in my case, I saw at least one guy at the Minor Emergency Clinic who just overlooked that his diagnosis didn't make sense. He really, really wanted a horse and told me it was a horse, despite the fact that the zebra made more sense.

I do have asthma, but they symptoms I was having did not respond to my inhaler. Also, for severe asthma problems, they generally put you on prednisone to bring things back under control. I had started prednisone for another problem a week
*before* my serious PE symptoms started. Yet, this PA told me I was having asthma problems even though I was already on the treatment that would have dealt with any asthma problems. He told me my asthma wasn't controlled, sent me home, and told me to take bendaryl.

The fact that I had a clotting history and now was having a hard time breathing didn't seem to register with him.

Thankfully, I went to see my regular doc the next day who thought it was *probably* a horse, but was worried about zebras. She consulted with my asthma doc and they agreed to send me for a CT, just to rule out the zebras.

Glad they did...

I have to agree with More2be on some of this. DVTs and PEs are way more common than doctors seem to think. Maybe they should move up to horse status and become one of the early things doctors check for when you have breathing problems...if only there was a cheap, easy, noncontroversial way to check for PEs...

I noticed both hospitals I was in when I was diagnosed hooked me up and did a quick EKG upon admittance. (By quick, I mean only about two minutes!) They wanted to rule out (or diagnose) a heart attack right away, which makes sense to me. Wish there was a good way to do this with clots!

But yeah, clots don't have any symptoms unique to themselves. (Wouldn't it be helpful if getting a clot caused your right thumb to have green polka-dots? Or something equally obvious?) Clots share symptoms with things like heart attacks, asthma, and pneumonia. So those wind up being the horses, and the clots are relagated to zebra status--especially for those of us who are younger, not on BC, don't smoke, and haven't travelled or been injured recently.

At some point, you DO have to trust yourself more. I didn't know it was PEs, but I did know it was something serious. Being told to go home and take a Benadryl did not sit right with me, so I went to more doctors until we figured out what the real problem was. For the most part, I do trust doctors but if there is anything I feel unsure about that they've told me, I tend to do my own research and maybe consult others. Doesn't hurt to get a second opinion!

Hm, interestingly, the zebra has become a horse in the UK, but only in hospital environments. In January they brought out new guidelines where every patient needs to be assessed for their DVT-risk!

Unfortunately this does not extend to community care yet: GPs, community nurses, midwives - they are not aware of the risks and still (mistakenly) think that it is more probable for someone to have a sudden onset of asthma that does not respond to inhalers, than a PE.

I am supporting a charity here called Lifeblood: The Thrombosis Charity and after their successful campaign to raise awareness in hospitals they are now aiming at raising the awareness in the community with their Spot That Clot campaign.
Can't come soon enough for me since my midwives haven't even heard of Factor V Leiden! And before my PE diagnosis last year I was fobbed off for three years by numerous doctors and nurses without them even checking my oxygen level - despite my family history and confirmed FVL...

Another zebra here. I walked around for more than two weeks with PE and after they finally caught it, they couldn't believe, 1, that I was still walking around, and 2, that I was alive.
I just found out yesterday that my BNP test showed I was in moderate heart failure on the day I was finally admitted. I guess that explains why I was in Cardiac Critical Care, rather than the ICU.
No risk factors, no answers yet either. I was very close to dying before they were able to figure it out. So frustrating to go to the dr and ER again and again, saying something is wrong, something is very wrong, and have them pat you on the head, give you some cough syrup and send you home again.
I am very grateful that overall I am pretty dang healthy, I am making a good recovery and very quickly too my doc says.
I guess this makes us a herd of zebras!

I, too, am a zebra that had to fight for my PE diagnosis (since they told me it was a horse - asthma). I've always been a zebra though and every health issue I've ever had has been the "worst case scenario" - to the point that all my docs now joke about how they can never assume anything is "no big deal" with me. I'm so glad I'm educated enough about my health and aware enough of my body that I can advocate for myself pretty efficiently - I just hope I never get so sick that I am unconscious and can't fight for myself!

I think Zebras are one of the most beautiful animals on earth.

I really think this discussion is interesting. I've actually kind of been thinking about it since reading it yesterday, and I get that idea, but I really agree with the comments that overall DVT/PE isn't put into the proper place, neither in the medical community nor the general population. Like in my case I really still believe that my DVT/PE was a horse. Despite being only 32, I had a horrid family history of clotting (though no known disorders), I was postpartum and had a really bad delivery which the doctors knew had injured me and had been pretty much immobilized since delivery. I had complained of sharp pain in my chest and trouble breathing ever since I delivered. The doctors went the whole asthma route with me too, but seriously, what's more likely? That a postpartum woman suddenly present with asthma that she's never had before and doesn't respond to inhalers, or that she have PE? Then when I present a couple of weeks later with DVT symptoms, what in the world would make them think there was no way I had a DVT? I get that these can be hard to diagnose because the symptoms are so commonly linked to other things, but seriously, there are some cases where there's just no excuse. Of course, the fact that we're all here pretty much means we're all some sort of exception to expectations. Also, interesting stuff the Occam's Razor....

Have a great day everyone!
Sarah

I have to agree, ShilosMommy. In retrospect, I really think my diagnosis should have had "horse" written all over it. I have a clotting history, I can't breath, my asthma inhaler/meds aren't working. I'm curious what it is about current medicine that makes PEs zebras instead of horses. Why aren't they thinking about this possibility right away? Are they reluctant to suggest this because the only way to prove it is super expensive (the scan)? I just don't know...

But my asthma guy said he was 99% sure it was something else (although he DID send me for the scan because "if [he] guesses wrong, [I] could wake up dead tomorrow). The folks in the hospital ran some sort of statistical analysis (this analysis is mentioned on Wikipedia as a diagnositic tool, but they give no details) and told me that my chances of having PEs was at 97%. They told me this AFTER diagnosis to show me just how amazed they were that I DID have PEs (and maybe to justify letting me sit for two hours while they argued with my asthma doc about doing the scan at all).

I'm having a lot of fun with this conversation too!

Let's see....

5000 visits to the ER end up being asthma related (per AAFA.Org)

770,000 people annually will have a heart attack and

Another 400,000 will be seen for angina (per Nat'l Heart Lung & Blood inst 2007 stats)

600,000 people develop PE every year, resulting in 25K hospitalized and a whopping 60,000 will die. Less than 10% of PE deaths were diagnosed. ( from FAQ archive article on Pulmonary Embolism, copyright 2010)

Which all goes to show, You can lead a Doc to water, but you can't make him think.

Keep in mind the horse-zebra thing has a geographical and cultural bias. If on the savanna, or some zoos, the only hoofbeats of the kind are from zebras.
Many have brought up the bit about trusting the doctors. Far too often VTE victims have stories of what doctors missed, did not treat, or just ignored. Still they are the gatekeepers of all treatments. "Trust, but verify", words I must appropriatly attribute to Ronald Reagan.

I'm a zebra. 5 weeks of increasing shortness of breath, no other symptoms until intense pain developed over 24 hours.

The very day I went into the ER I saw both my GP and my pulmonologist for these very issues. They both declared me 100% healthy, must be (pick one) anxiety, exercise induced asthma, bronchitis, etc. Lung tests and oxy walks were perfect. Labs were perfect. Cardiologist had declared my heart 100% jst days before.

Couple hours after seeing the GP/pulm, was admitted in Serious condition.

Honestly, though, I don't blame them. hindsight is 20/20 and all. My doc friends said they wouldn't have thought of PEs either.

Chris