Chasing Horses and Zebras

Yes, You Read That Right

I. During my preteen horror phase, I read a quote in Robin Cook’s novel Contagion that continues to stick with me: “When you hear hoofbeats, think horses, not zebras.”

The medical profession uses the mantra to remind themselves symptoms point to the most obvious answer—not the most absurd. (Unless you’re watching a made-for-TV drama, in which case everything, including alien-borne viruses, is possible) It’s designed to keep fresh-out-of-medical-school Dougie Hoswers from diagnosing everyone who sets foot in the office with a bloody nose with Ebola.

But the safety rail also causes others in the profession to walk around with blinders. The easy answer becomes the only answer.

Never mind the repercussions.

They forget that, on very rare occasions, hoofbeats can signal zebras. Or giraffes. Even buffalo.

This not only leaves the condition to fester and grow in ignorance, but it also causes the patient to question everything from the input they’re receiving from their body to themselves and their confidence.

While the stampede gets louder.

And louder.

II. In January, my doctor sent me for a CT scan.

I don’t even remember which doctor or the reason for the scan. Everything always begins to blur together by the end of the year.

Was I brave enough to give voice to a new pain? Commenting on an old ache after enough downtime to hope the doctor had forgotten we never found a reason in the past? Checking a box on some random list of “health screens” that never make sense to a body obviously devoid of health? Or did they send my orders in by accident?

I know the scan came back clean.

Because that’s how my body and its foibles work. Regardless of what I feel or convince myself is wrong, the tests always point to absolutely nothing. (If I’m not on the verge of complete insanity, where’s the fun?)

Check the box and move on.

To April, when I found myself in the ER wishing (among other things) I had never agreed to remove the stones from my kidneys. And another CT scan; because if I visit the Emergency Room and don’t receive a CT scan, have I actually been?

This time around, though, the report threw in a curve ball.

Oh, my kidneys and their attached stents were perfectly fine. Nothing unusual there, despite what my body continued to tell me. (“Bitch, if you don’t get these things out this second, we are shutting down!”)

But the scan included a fatty liver as a bonus. Nothing the ER felt like addressing (it wasn’t on my Problem List and, therefore, did not count as a concern), but something I should “Bring up at my next PCP visit.”

Unfortunately, the previous day’s procedure canceled out every screwed-up value on my lab work. (Stress is so magical) The doctor was uninterested in anything beyond discharging me to free up the chair in the hallway.

I was a “horse:” A healthy post-op patient.”

Concerned that a liver proclaimed “uninteresting and unworthy of any kind of mention beyond ‘yup—there’” in January had suddenly become “fatty” and earned a notice, I scheduled a doctor visit. What the hell happened?

Where did my beautiful liver—so free of issues and pain—go?

Laying out my concerns and reminding my doctor of my (relatively—by doctor standards) clean bill of health from the beginning of the year, I showed her the villainous CT scan.

“Everyone has fatty liver these days,” she told me with a smile. “You just need to lose 20% of your weight, and it will go back to normal.”

I stared at her, uncertain what words to use first. Had I gained weight since January? (No, the answer was “NO!”) Was I like everyone? (Wild guess on what the answer to that question was) Did she have a magic wand on how I was supposed to lose 20% of my body when I’d been struggling with my weight for 46 years? (Three for three, people)

Before I could say anything, she relented and scheduled an ultrasound of the liver.

To confirm the CT results.

Because machines lie?

Or maybe they get bored with scanning the same person over and over and over and over and over and over again. And decide to throw something new into the mix for the hell of it?

III. So far as my PCP was concerned, my liver was nothing more than a horse: Textbook fatty liver disease. Two visualizations confirmed the presence of an unhappy organ.

Reason? Unknown.

My labs continued to look as normal (and disgustingly healthy) as always. I’d constantly poked fun at Tim for having better cholesterol levels than him. They’d barely wavered since I started keeping track in 2013. I didn’t drink. Courtesy of the alpha-gal, I rarely ate out and certainly didn’t touch fried or fatty foods. Most of my diet consisted of plants.

When I pushed my doctor, her only response was my medication list.

The drugs keeping me from turning into a comatose bundle of raw nerves. Only one of which (according to my research—and confirmed by her educational background) posed a problem to the liver: the estrogen patch. Which I informed her could come off over my dead, overheating, sweating corpse. I then proceeded to get a confused look from my OB-GYN when I accused him of sabotaging my liver.

Estrogen at my dose (literally the lowest) shouldn’t cause problems. And if it did, I would have seen issues THREE years ago when I started the patches.

I spent nights poking myself in the side, having silent conversations with the lobes in my abdomen. No explanations ever came back, of course. But at least it seemed to listen to me.

Then my doctor relented enough to run a new set of labs.

For the first time in my life (okay, more like the third), blood work came back abnormal: My iron levels were high.

She immediately accused me of taking iron supplements. (“Blame the patient” is an unspoken medical mantra) I dutifully read off the milligrams in my multivitamin. Even went so far as to check the amounts of iron in my Meusli, soy milk, granola bars, protein bars, and jackfruit tenders (negligible—in case you were curious).

I hadn’t touched an iron pill since my hysterectomy.

While juggling anxiety over what the result meant (What caused it? How did I get rid of it? Did it mean something dangerous?), attempting to figure out a reason for the iron overload, and contemplating whether this finally meant my liver getting attention, I sighed with relief. Maybe I was a zebra, but I wasn’t crazy! Something was going on! Now my doctor would take me seriously!

She told me she’d recheck it in six weeks.

That was all.

IV. The human body doesn’t have a plan for excess iron. Well, aside from storing it. (Maybe for a rainy day. Maybe for some unspecified hemorrhage event in a hypothetical future) Your liver isn’t exactly thrilled about tucking iron inside—especially if it’s already ticked off for…well, whatever reason it was upset to begin with. The only way you eliminate extra iron is to bleed it out.

Yeah—turns out those Leeches from the Good Old Days got one thing right!

My iron, of course, went higher.

My doctor repeated the “iron supplement” dance. And even though I’d already torn the house apart looking for suspicious iron deposits, I let doubt invade my brain and did it again. (No mysterious spirits injecting me overnight)

She suggested I stop my multivitamin on the off-chance it was the culprit; suggested checking it again in six weeks.

I suppose constantly drawing giant tubes of blood was one way to get a handle on the problem. Having surgery on my elbow probably didn’t hurt, either. Surgeons aim to minimize blood loss, but there’s always going to be some kind of bleeding when you cut the body open.

No surprise, then, that when my new PCP checked my iron, it came back normal.

Or was it surprising?

I didn’t even know.

She, at least, felt the previous results indicated something amiss in my body and sent a referral to a Hematologist. The name sounded fancy. A person whose sole field of study revolved around blood. It was another glimmer of hope.

Of course, she insisted on running an entire slate of tests, herself. Seven tubes of blood. By then, I think I’d donated a quart to the labs.

Two new abnormal came back for auto-immune—both unspecific. She didn’t dismiss them, per se, but she punted them down the road to the Rheumatologist. Who didn’t have an appointment available until January. (Two new doctors for the collection. Pretty soon, I’ll have seen every specialty there is)

The referral to the Hepatologist remained ignored. Even now.

I guess everyone does have fatty liver.

One more horse for the roster.

V. I filled thirteen tubes of blood for the Hematologist. Counted each one as the technician cycled through the colors. I’ve never filled that many in one shot before. (I doubt my iron will come back high)

He wasn’t looking for horses.

For the first time since I started admitting symptoms to anyone with a medical license, he used zebras to discuss what might be happening in my body. Diagnoses I’ve seen in my trips through Google but always dismissed because…well, one, because it was Google.

But also because they sounded absurd and ridiculous when I started reading them.

They may end up remaining zebras—safely ensconced on the savannahs of Africa.

Or I might walk into my recheck appointment and discover I have one hanging around my metaphorical backyard.

Which is a sentence I never contemplated before.