Which do you prefer, Horses or Zebras?
I had a professor in Dental school who always said when you hear
hoof beats think horses not zebras. What
does mean? It means that in the worlds in
which we live the horse is much more common, whereas the zebra is more rare and
exotic. So, when troubled by making a diagnosis,
think common, more probable first, then widen your scope to the rare. (think common cold before rare virus from across the world, where you have never been)
In medical and dental school we are bombarded with all types
of information and knowledge, much of it necessary, but some of it a bit on the
fringe.
I recently had a patient in, whom unexpectedly and quite suddenly
had some pain in her face below her right eye.
It subsided a bit but the next morning when she awoke it was slightly swollen,
and quite painful. Her sister works for
an ophthalmologist, so her sister recommended that she come into her office for
an exam, because if here is an infection in you r eye you could lose your
sight. Logical and rational.
The ophthalmologist saw the patient for the pain below her
right orbit. He concluded that it was
not eye related and sent patient to the ER for facial pain evaluation. In the ER they thought there might be a small
stroke. The patient had CT scan at hospital,
no stroke, no sinus issues noted, but they unable to determine cause of
pain. The ER gave her pain meds sent her
on her way and told her to perhaps call her dentist.
Luckily for our patient we are one of those offices that bend
over backwards for our patients, especially those in pain. We were able to see
patient immediately following, she was very grateful and expressed it several
times saying that we never fail her.
Pain was below the right orbit in line with root structure
of teeth #5 & 6. 1 periapical x-ray
was taken of #6 since it has the longest root.
No lesions noted. Pulp tested the
teeth in the area.
Tooth #5 tested at a level determining that the nerve was
dying and a probable cause of the pain.
Patient was advised that the tooth would most likely need
endodontic (root canal) treatment. On the
x-ray, we showed her how low the sinuses were and how close they were to the
apex of the tooth and that this would be a better treatment than extraction.
After root canal therapy the pain went away.
The reason I am retelling this story is that simple
solutions go a long way. As Physicians
we are all limited by our scope of practice and what we are familiar with. Facial pain could be your eye, your nose,
your mouth or perhaps stretching a bit a possible stroke. You need to be vigilant in your own health
care process. Look for solutions,
address the poignant issues and seek all areas of help because your problem is
more likely a horse rather than a zebra.
Just Sayin’
