No elephants in this room…just zebras

During my doctoral program in physical therapy, I had a professor who always cautioned me and my classmates to “think horses, not zebras!” in an attempt to get us to examine the most likely reason for a patient’s complaint. This saying or aphorism was shortened from “When you hear hoofbeats, think horses, not zebras” made popular in the 40’s by Dr. T. Woodward at the University of Maryland School of Medicine. The idea behind this is that medical interns will usually think of the most obscure and unusual diagnosis before the likely, but more commonplace, diagnosis. I will freely and readily admit, that when I see patients in the chronic pain population, I begin immediately to think of zebras and NOT horses whenever I hear hoofbeats.

Turns out, when the animal appears it’s usually a zebra…

Generally, in conventional medical practice, the horse’s hoofbeats are often thought to indicate simple musculoskeletal problems, but, in my experience, these hoofbeats actually belong to zebra shaped autoimmune diseases. Patients come with charts full of seemingly unrelated symptoms that demonstrate a lifetime of malaise.

What do some of those symptoms look like?

Fatigue Weight gain Poor sleep
Joint pain, muscle pain Weakness Cold/heat intolerance
Dry eyes, skin, mouth Belly pain/dsicomfort Bloody stool/mucus in stool
Frequent/recurrent hives/rashes Weight loss Numbness/tingling at hands/feet
Hair loss Brain fog/difficulty concentrating Rapid heart rate, and many more…

When viewed in isolation, you may think how do they live with all this?


More to the point, ask yourself “How well am I living with this?” That’s a tough question for a medical practitioner to ask herself-but I had a patient put me on the spot in just this way one day prior to my own diagnosis of Hashimotos/autoimmune thyroiditis…

So, does your chart show up like a rorshach of autoimmune symptoms, do you go to your doctor with frequent complaints (or avoid him/her altogether because you’ve been brushed off too many times), or have you seen multiple doctors never really feeling like your health problems have been solved?

If you suspect this may apply to you, ask your doctor specifically about autoimmune markers on your blood tests, or find a functional medicine practitioner/doctor or naturopathic doctor. They may or may not be covered by your insurance but are usually willing to provide you with a superbill that you can submit to your insurance.

Also, watch this set of videos called The Betrayal Series put together by Dr. Tom O’Bryan. Have more questions or are you looking for more answers? Please check back here often, for resources, or send me an e-mail:

Thanks for reading!!


I am a wife, a mom, and a Doctor of Physical Therapy on my own journey to wellness. No stranger to pain and discomfort, I've had migraines since I was 10 years old and was diagnosed with Hashimotos Thyroiditis in 2011. Someone I greatly admire counseled me to become a connector...that is my purpose with this blog. I pray it is a blessing to you!

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