Changing Our Stripes: Sometimes It IS a Zebra
As a new professor at PNWU, I've often struggled with what to teach first- and second-year medical students.
They are bombarded with information during their first two years of medical education, so I was advised to stick to the basics. After all, they will get more depth in their clinical rotations and residency. So, what should I focus on most in those first two years of their medical educations?
“Stick to the horses!”
A reference to an adage that not only pertains to medicine, but apparently also medical education, the idiom states that “when you hear hoof beats, look for horses, not zebras.” Essentially, use the clues you are able to identify and use them to look for the most likely answer. In medicine, this means that illness is most likely caused by something commonplace, not something exotic.
That seems simple enough, right? So why did I find it so challenging, you ask?
I had spent 18 years at a “zebra ranch.”
Not an actual zebra ranch, but an institution that specialized in uncommon and rare forms of cancer. For me, zebras were the commonplace. We would have to pause when presented with a horse.
I remember being impressed with the referring physicians who were quick to recognize that their patient was not experiencing something commonplace and knew to refer their patient. Those patients usually had a better outcome because we could start treatments sooner. So, I thought, “I am going to at least introduce my students to some of the zebras so this information will start to stick in their heads.” That way, if they ever have a “zebra,” they may act quicker and more effectively.
I then did what all new professors do: I got really sick.
It turns out that being exposed to hundreds of students also means you get exposed to lots of bugs. In my case, I got a bad cold that caused me to lose my voice – which is not good for a lecturer. That eventually turned into severe bronchitis.
After spending several days at home turning lectures into self-study material, I was starting to feel better. However, I woke up one Sunday morning and was having a hard time hearing. “Great”, I croaked to my husband, “I can’t talk and now I can’t hear!”
Frustrated, I headed to my office to catch up on some work.
Over the course of that day, the ringing in both of my ears only intensified. On top of that, I had a loud “swooshing” sound and rhythmic clicking in both ears. (Who knew losing your hearing could be SO loud!) On my way home, I noticed that the voices on the radio were not just softer, but distorted. No matter how loud the volume was, I couldn’t understand the words! It was as if they were speaking a different language altogether.
“Wait a minute,” I thought, trying to decipher song lyrics and radio advertisements, “this isn’t a simple case of congestion.” I had heard about this in my training. This could be very serious.
Then it hit me: do I have a zebra?
As soon as I got home, I did what I was trained to do – I looked it up on Google.
But I did use Google to direct me to some great on-line medical references.
I had the symptoms of Sudden Sensorineural Hearing Loss (SSHL). This is a rare, rapid hearing loss, usually in one ear, that can occur over the span of several days.
Mine happened over the course of a few hours and was in both ears – even rarer. It appeared that the hoof beats I’d been hearing may have not only belonged to a zebra, but one with some pretty unique stripes.
The cause of SSHL is not clear, but can be precipitated by a viral infection. The next steps were crucial.
Start steroids immediately. Take special hearing tests to confirm this was not congestion. Visit the ENT.
If I didn’t act fast, I would most likely have permanent hearing loss.
After testing, the diagnosis was confirmed and I had lost about 70-80% of my hearing in both ears. I was fitted for hearing aids, took 2 rounds of steroids, and waited (patiently?) for my hearing to return.
Today, I’m happy to say that it has mostly returned. I no longer have to wear hearing aids, and can no longer use my hearing loss as an excuse to ignore my husband.
Despite that fact, I am lucky.
Most patients are initially treated for severe congestion for weeks before they begin treatment for SSHL. This delay in treatment can lead to significantly decreased and permeant hearing loss.
I wish I could remember the particular class I learned about SSHL – I would thank that professor for planting that seed in my head (and send them a bottle of wine (Yakima!)). Instead, I will continue to teach the students a bit about the zebras. After all, someday the memory of those odd stripes may come back to them when they need it most.
After all, my time on the zebra ranch helped me to continue listening for sounds of hoof beats – horses, zebras, and maybe even a unicorn or two.
Julie Habecker, PhD
Associate Professor Pathology
College of Osteopathic Medicine - Biomedical Sciences
Pacific Northwest University of Health Sciences