Diagnosis – Horse vs. Zebra


After the onset of tremoring, which I thought was a bizarre medical reaction to the combination of an antibiotic and a muscle relaxant, I waited a while after I was through the antibiotics to get all the drugs out of my system.  Still no change in the tremoring, which seemed to go on all the time.  Ignoring wacky medical stuff and hoping it will go away is my usual modus operandi, but this strategy wasn’t working…so I finally broke down and went to a General Physician in early July.  (My own trusty doc was on sabbatical.)

The General Physician did a few muscle strength and reflex-type tests and then dispatched me to a neurologist.  I don’t recall her using the dreaded word “Parkinson’s” but she must have, as the scheduler was trying to get me into the neurologist who specialized in Parkinson’s.

That would have been two months away — unacceptable!– so after much negotiation with the scheduler, I got an appointment with another neurologist a mere three weeks away.

Horse vs. Zebra

Much to my surprise, there is no objective diagnostic test for Parkinson’s – you don’t (say) take a blood test to determine how much dopamine you have.  So the diagnostic skill of the physician is paramount.

On the first day of med school, they teach the young rookies about the horse vs. zebra concept in diagnosis.  That is, if a 4-legged, hoofed mammal with a mane and tail is presented to you, you should diagnose as a horse, not a zebra – in other words, go for the simpler, more obvious diagnosis first.  I was really hoping there was some simple explanation for my hand tremoring.

My neurologist did more extensive muscle strength and reflex tests with me.  He asked me the expected questions about family history (nope, no one had Parkinson’s) as well as some unexpected questions like, how’s my sense of smell (lousy), did I grow up with well water (hmmm, yes, for my first six years).

His conclusion: I had “Parkinsonisms”, that is, I had symptoms characteristic of Parkinson’s, but he wasn’t ready to say I had Parkinson’s yet.  He sent me off to have an MRI.  In the meantime, I clung to that “ism”…maybe the tremor was something perfectly benign…indeed the General Physician had said there was such a thing as a “benign tremor”.  However, I wasn’t fooling myself myself very well…every stumble I took or pause in my thinking, I would wonder: “Is this Parkinson’s?”  I deliberately didn’t look up anything on the web because I knew that would freak me out even more than I already was.

“It’s a horse.”

I returned to the neurologist on August 16.  We went over the MRI, which was to determine if I had had a stroke.  (A stroke can cause tremors.)  This seemed wildly unlikely that I could have had a stroke without knowing it, but apparently this is possible.  The MRI did not show any evidence of a stroke, and at last provided me with film evidence that, unlike Dorothy’s Scarecrow, I really do have a brain.

The neurologist ran me through more muscle strength and reflex tests, and then whipped out his iPhone to film me walking down the hall.  Much to my astonishment, I was holding my right arm as if in a sling.  Muscle rigidity like this can be a symptom of Parkinson’s.

His conclusion: I had Parkinson’s disease.  I asked if this were a “horse” or a “zebra”.  He understood the reference and immediately said, “It’s a horse”.  This scary statement kept reverberating in my brain.  I finally recovered enough to ask,  “What would be a zebra?”  He said the stroke, which we had now eliminated.

Second opinion

I asked for and got a second opinion, same hospital, but this time from the neurologist who specialized in Parkinson’s.  His conclusion on October 16:  Yes, I had all the “classic symptoms” of Parkinson’s.

By this time, I had had enough tremoring to accept that I had Parkinson’s.  This second opinion just confirmed my decision to retire in order to manage the symptoms.


I’ve been asked what was my reaction to getting a diagnosis of Parkinson’s disease. I don’t think I had just one reaction, but instead bounced among fear, acceptance, detachment, and other emotions.  I asked my husband what his reaction was, and he had the best summary word:  “Disconcerting.”  I felt like after you’ve gone through an earthquake and realize the ground beneath your feet is no longer assured to be stable.

About Laura Kennedy Gould

Author of magictrickparkinsons.wordpress.com "The Magic Trick -- Life with Parkinson's
This entry was posted in Parkinson's Basics and tagged . Bookmark the permalink.

One Response to Diagnosis – Horse vs. Zebra

  1. Pingback: Parkinsonisms vs. Parkinson’s Disease | The Magic Trick – Life with Parkinson's

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