The Four-Handled Cup

The Four-Handled Cup

The Lyme Times

Volume 33

6/1/02

by Virginia T. Sherr, MD

Joanne looked at me in utter anguish. "I've 'lost it.' You have to help me." My mild attempt at humor - "Lost what exactly?" - did not even rate a thin smile. As it turned out, she was in a state of near panic over a realistic fear of losing her wits.

"My entire career was spent running a complicated business office," she began. "It was my responsibility to see that the company ran like a fine Swiss watch. The demands were incredible so I had to handle them by coordinating everything - all the unexpected glitches, mishaps, and misunderstandings. I did it well. I could do many things at the same time: talk on the phone, create directives for the staff, add up a column of figures, and download data on the computer - never even feeling ruffled. I loved the challenge of it and enjoyed my job. I liked the excitement, but most of all, I enjoyed creating order out of chaos!

"Staff members appreciated my skills, too," Joanne continued. "They had an office party for me once and gave me a gift - a pretty cup, but an odd one. It had four handles and an inscription 'You can handle anything'. Nothing I ever received meant that much to me. Now, I can't even bear to look at it because I felt I had to resign my job due to changes in me. I got so I couldn't multi-task anymore. At first, I just noticed I was having trouble doing more than one thing at a time. Then I got confused at what people said to me, at what I was supposed to be doing or what I had done with even one thing. I couldn't keep straight the decisions that I had made and who I had told about them - even if I remembered having made them.

"When I began to misplace important data and to lose my personal things, I knew I was adding to the disorder, no longer creating order and that double-stressed me. I began to obsess about it day and night. The thoughts of my possibly having disrupted the business and added to the chaos were the worse ideas of all. Those thoughts tortured me. I couldn't stand it. I conjured up all kinds of terrible disasters that might result from my ineptitude. I could not sleep then either because of these fearful thoughts. Completely exhausted, I resigned from the most ideal, best paying job I could ever have had. But even that did not help! I continued to obsess, thinking the same thoughts over and over again, which still left me unable to sleep. Please do something for me because I am not myself. I am irritable, and I wake up tired because there is something wrong in my head. I am so afraid I am going crazy."

I found myself wishing that I had known Joanne before she resigned her much-loved job. She had no idea that her central nervous system was infected from a nine-year distant, untreated tick bite although careful history taking and my advanced reference laboratory testing for spirochetal DNA showed that to be true. Luckily, she was able to achieve sound medical improvement with the help of two physicians who specialize in the treatment of Lyme disease. A widely experienced Colmar, Pennsylvania, physician worked with her for a year, treating her with several antibiotics as it became clear to him that these were necessary. Her headaches, confusion, irritability, fatigue, esophageal spasms, TMJ, muscle pains, restless leg syndrome, and night sweats (all due to tick-carried Lyme disease, ehrlichiosis, and babesiosis infections) abated. She was delighted and grateful.

Joanne's Lyme-magnified obsessive thoughts and tendencies to constantly recheck things in an effort to create outward order as a partial antidote for her inner confusion began to respond to my prescriptions of Zoloft when given in sync with the antibiotics. Fortunately, the maintenance dose of Zoloft was reducible (often not the case) as she improved physically. Zoloft (sertraline) is an anti-depressant medication frequently used for the treatment of obsessive-compulsive symptoms. When eventually, following a year without needing any antibiotics, her somatic symptoms began to recur, Joanne chose to seek help from a Lyme specialist in Bala Cynwyd, PA because of his well-known work in repairing Lyme-damaged immune systems. He encouraged her efforts in boosting her immune system against infections while continuing her antibiotic and anti-babesiosis medications as needed.

Joanne was triumphant during her last visit to my office. While she had been maintained on Amoxicillin 1000 mg three times daily during her second year of treatment, she and her doctor had been able to discontinue it totally approximately three weeks prior to that session. She enthused, "I have come so far. Now I can do several things at once again. I would suffer all the aches and pains I have ever had in preference to having that mental anguish again. Now, I even have figured out how to deal with the few obsessive symptoms that are left over.

"What happened to me was like a trip to hell! I never want to return there! I'm getting that four-handled cup out of the closet and inviting over old friends from the office. I haven't wanted to see anybody socially for more than 2 years but now I am ready. My husband and I are going to celebrate my escape from Hades with them."

Later, I heard from her sister that the reunion became quite a party what with the 4-handled cup getting a real workout. Apparently those present thoroughly enjoyed toasting the fact that Joanne and her doctors had salvaged what she understandably believed she had lost forever - her own mind.