The Zebra and Chronic Illness

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Have you ever heard the saying “When you hear hoofbeats, think horses not zebras”? There are many slight variations of it, but the gist is the same.

This is a common medical school saying. The “horses” are common conditions, whereas the “zebras” are rare conditions. This saying tells doctors to think of more common causes of symptoms and ignore rare conditions.

Why the zebra?

A lot of people in the chronic illness community call themselves ‘zebras’, which stems from this saying; “When you hear hoofbeats, think horses, not zebras.” We are zebras – people with rare conditions.

You will also find a lot of people with Ehlers-Danlos Syndrome call themselves ‘zebras’ too because a zebra is the logo of the Ehlers-Danlos Society.

The harm caused by this saying to patients with a chronic illness

“When you hear hoofbeats, think horses, not zebras.” This saying can be harmful to chronically ill patients because if they have an undiagnosed rare illness, symptoms are often called “functional” or are put down to anxiety. Symptoms of these are similar, but functional disorders and mental illnesses are not always the cause of them.

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There are a lot of so-called “invisible illnesses” which are not actually ‘invisible’; some can be seen if you look in the right place. An example of this is Ehlers-Danlos Syndrome. Many doctors have not heard of this, so don’t know that hypermobile joints, gastrointestinal issues, stretchy skin and many other symptoms that affect any part of the body are characteristic of this condition. Putting EDS symptoms down to anxiety can cause more harm than good. “Do what you enjoy” is what many doctors tell patients with anxiety, but this can cause EDS (and other chronic illnesses) to get worse and it takes a very long time to get back to where you were.

Moral of this story: Don’t ignore the zebras!


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4 Replies to “The Zebra and Chronic Illness”

  1. I have always called myself a Zebra because nothing is ever common with my health. I never have a normal presentation of any condition and I have to continue to push and fight to get doctors to do something and not just give up. It’s exhausting and so hard to mentally cope with

    1. I’m so sorry you have to do that. I’d never heard the saying until I watched Grey’s Anatomy and didn’t consider myself a zebra until I found the chronic illness community on Instagram

  2. Don’t forget the zebras! I actually only come across the zebra term on blogs for those with EDS rather than chronic illness in general. Such a good point about illness being put down to anxiety, that angers me so much; patients all too often are fobbed off with that, and I hate to say it but women often bear the brunt of being seen to be ‘hysterical’ or anxious (a historical thing really), when actually they’re just frustrated with being ignored and their health declining. xx

    1. Yes, don’t forget the zebras! It makes me so angry when people put everything down to anxiety, too xx

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