A Lyme Disease Case

by Richard Pitt

Feb 2005:

2 years ago, I thought had a RSI (Repetitive Stress injury) which went into the shoulder.

The pain was very intense, it went to the shoulder, which became frozen, I couldn’t move it. Even any touch aggravated.  I couldn’t work. I was off work for one year, I lost so much strength in my arm and wrists. There was no strength, I couldn’t drive. I went back to Canada and to a RSI clinic. In 1999, I had a discoid rash and swelling of ankles and had 3 weeks of antibiotics (AB’s). I was living in San Francisco and was hiking and had dogs.

I went to a person who specialized in Lyme disease in may 2003 but the tests still were not definitive. I wanted her to do more AB’s but didn’t. I began to work with Chinese treatment and other natural therapy and did that for one year. I went back to work January 2004, and the shoulder began to get worse and then in March, I had a pain in my wrist and swelling when I lifted something. Then in May I went on AB’s, at same time my back went. It was very painful, I couldn’t sit down. I could feel my muscles tighten and had stabbing pains. I didn’t go back to work in September. I am now doing rehabilitation Pilates, I also saw a chiropractor who said 2 joints are not firing in my neck.  My body has tended to flare up, if adjusted too much.

I am still on AB’s, since May 2004 ,zithromax 600mg and Omnisef 100mg.

Dr said my white blood cell count is low. Three years ago, (Jan - May) I had a sinus condition that wouldn’t go away and was on AB’s for 6 months. Then I had surgery on the right sinus.  It was blocked off. It was shut off, I had pain in my teeth and sinus. I had a horrible taste and smell.

I was also on Mepron and Zithromax for babezia.

My weight is  down 17lbs in last 18 months. Now I weigh 117lbs. I am now eating meat again. In 1999, I went to Canada and tested for Lymes’ which was  negative. The Dr thought it could be Lofgrens’ syndrome, a type of sarcoidosis.  I was negative for RA.

HOW DO YOU FEEL NOW?

My back is bad, it is difficult to sit and stand, I have to stand, feels > then but < if stands too long. Pain radiates down the right leg. My left shoulder is not in full motion, but pain not so bad now. My right shoulder wings out. I am very weak, my muscles are not toned.

There is tension in my wrist if I pick heavy things up. I have to be careful what to do with my hands. It flares if I do anything. My veins pop out if it flares. Since May, the level of pain is > in the back, not so drastic.  I am doing Pilates 3 times a day and am more flexible now.

I am sleepless, I wake up thirsty and drink a lot of water,  I wake 2-3 times to go to bathroom and also restless. I sleep on my back, if I shift my head in sleep I wake up. Since my shoulder is bad, I am afraid to move. When I wake up, my legs feel are heavy, like lead. My muscles are not firing in the right order, when walking my back is overcompensating. I am retraining muscles to work in the right way.

Last year, I could barely walk, it was very painful, I felt someone stabbing me in the back. The pain extended down the leg, I would feel nerve impulses, electrical in the back. Stabbing pain was < if sat down. Pain < lumbar region, told now there’s scar tissue.

YOUR LIFE NOW?

I am doing a lot of Pilates and studying again, finishing off a masters degree. I have a therapist.

In June 2002, I was doing lots of keyboarding, also lot of stress at school, and had pain in the right wrist.  I was doing lots of physical things also, I went back to work in September, and still had pain in the right wrist, it felt exhausted. Then in November, the left shoulder began to aggravate. One time on phone with ex. husband, it began to hurt.

Then I carried a big bag and felt it was on fire, right on end of shoulder.

Nothing would help.  When bad, heat would >.  (3) The pain then began to extend down the arm, I felt as if I had been punched and a steel pull run through the shoulder. I had nerve impulses in arm, as if somebody was squeezing my arm, like blood pressure taken all the time. But I have not had nervy, Lyme sx since march 04. Now in my hand, gets ache and tiny pin pricks.

There is tightness in the chest, my knee clicks, my right upper eyelid twitches. In my neck, there are shooting pains on and off. In 98-99, my husband and I were having problems and splitting up, it was difficult times then. I had headaches. I had first symptom of Lyme just as we split up. I moved out 2 months later.

1st sx in 99, my ankles were achy, as if I had run for miles, achy and sore, as if twisted them, then they both swelled up.  My ankles stayed swollen for months.  

Took Iburprofin to help the swelling. Then I was OK till 2002 when had sinus problems.

HISTORY:

Lactose intolerance when a baby.

Tonsils out, age 4.

Chicken pox and measles.

Candida in high school.  < again since 02.

Was on BCP from age 17 till 35 and back on again in 2001. Now not on it.

Menses: twice in 6 months, came early. No big symptoms with it.

From age 12 had intense pain in right abdomen.  Every two years, it occurs. It can wake me up in the night, intense sharp pain, almost takes me to ER, thinking its appendicitis.  I think it is the ileocecal valve. Stress can agg.it. The pain is like someone is squishing and twisting, I can’t lie down straight, crunched over, It takes 4-5 hours to pass and is > passing bowel.  

One time, I was walking a lot, and then got pain on top of the foot, it looked swollen, puffy, nervy kind of pain.  It is > now.

FOOD:

Likes  peanut butter, yoghurt, white fluffy bread (not eating it now).

TEMPERATURE:  

Likes warm, not too hot.  More cold then warm.

Hands get cold, and feet can also get cold.

DREAMS:

Violent, last 18 months.

- a little boy and a man, who was packing a suitcase and the boy began playing with pencils.  I was looking but they couldn’t see me. The boy threw them all over the place and the man picked him up and hung him by the ankles, then hit him so hard he went limp. I was horrified by it but was on the outside and couldn’t do anything.

Over 18 months ago.

- a woman,  I was behind glass, she was wearing a helmet, foaming at the mouth and someone was raping her from behind. I was saying, we have to do something and yet this person beside me said that she was choosing to be there.  (this one was after my back went out about 6 months ago.)  (This was also the time when my friend/ex asked me to go and live with him.

-  a group of men running after this man, they attacked him and sexually assaulted him.

- with my sister’s 3 kids, and one was abducted and then lost another kid and had to tell my sister, helpless feeling.

MIND:

Fears: turbulence, flying.  had one turbulent flight to Australia and < since then.

When I see sinking boats, it gives me the shivers,  half in and half out.

Anger?

I am even keeled.

Confrontation? 

It is hard to do it, I internalize things, getting but > now.

The year that wrist happened was the year that I confronted my principal.

Grief?

The end of my marriage was traumatic, we were married five years, together for ten. We are best friends now.  He had drug issues then.

I had a tumultuous relationship with my parents, but nothing too much. Father was not into kids, he was authoritative, I couldn’t question him. Why? It was because he said so. My mum was controlled by him.  They weren’t happy, they didn’t even share a room. I have a twin brother and a sister.

I was attacked in college, I was walking home and an older man fell off the sidewalk and I helped him up and walked him home. We walked into his house and he locked the door and I got out and ran to the door, and he slammed me against the door and hit me.  I managed to get away. I had weird dreams after that for one year.

The same kind of violation happened last year, at 6pm, a guy on the bike threw himself at me and threw me against a fence, I screamed and he got on his bike.  I was shocked by this. 

In 89, I went to Columbia and stayed one year, I went to see my brother there.

I got involved with a guy who fell in love with my brother. Then I went to S Africa for 9 months. Also went to Australia for one year and I taught in Tunisia for one year.

Stabbing pain in the back?

It is like there’s no warning, it is sudden, have to get up fast. > standing, then can feel something tightened.

Your feelings with that?

Fear and disappointment, that I am not able to sit with that. A lack of control. I can’t sit.

My shoulder pain also happens suddenly, with no warning.

Any other traumatic event?

I got into another relationship in June 03, and he moved in with me.

My husband came back to town and he wanted to be with me again. I was on the phone with him and I could feel my shoulder. I felt guilty as I had abandoned him. And within a week, the shoulder thing happened. When on the phone for 2 hours, some pain in shoulder and burning, but then two weeks later the shoulder came.  I kept it all inside.  I wasn’t sure that I made right decision then. I had waited 2 years by then.  I was conflicted. I was in his car one week later and he slammed the brakes to avoid a car and I used my arms to stop going forward, no repercussions then, but then the shoulder got worse. I was full of anxiety that night, and didn’t tell my boyfriend, I kept it all inside.

All the other things, were dramatic but I got on with it, but I probably internalized it. After this, I felt conflicted and then 6 months later, he called me, and at that time, I was not getting on so well with my present boyfriend. The next day, I asked him to leave.  

Now I am not together with anybody, although both of them want to be together with me and I’m still friends with them.

FAMILY HISTORY:

Brother - back problems, degenerative disc disease. Bone cancer in arm - age 6.  tinnitus.

Sister - spinal meningitis.  scoliosis.

Mother - osteoporosis.

GM - RA.

Father - broke back in 20’s, cast for one year.

M - Lost her first child at birth 3 years before us. She felt Dr made a mistake.

She never saw the baby and never forgave my father for signing baby over to Science.

We were all born caesarian after that.

Shoulder?

It feels like a big steel pole rammed through the shoulder.

The weight of world on my shoulder.

Analysis:

This is a chronic case of Lyme Disease with a clear etiology and a classic symptom picture, developing from the initial bite and infection and even after treatment with antibiotics, the development of secondary chronic conditions. The initiation of more serious chronic symptoms seemed to develop after she took antibiotics for a serious sinus infection in 2002, which then led to the development of serious joint pain and inflammation. 

The initial episode also coincided with difficulties she had in relationship. Four years later, her old husband came back into her life and the confusion this ensued being with her current boyfriend also exacerbated her condition. She subsequently left her boyfriend but did not get back together with her ex-husband. One other factor that came out in a subsequent interview is that she was still talking to her ex husband on the phone every day, at times 2-3 times a day. Even though they were not discussing being together, he was very much part of her life still even though he was still living in Canada and she was in the US.  This issue of her boundaries and self-identity therefore becomes a key psychological feature in the case as it progressed.

She came over as being pleasant, mild, friendly but not a strong character. Physically, she was very thin, blondish hair, somewhat wispy and slightly fragile looking. 

She is still on antibiotics for the chronic Lyme and some sy,mptoms are better but she is still very sensitive physically. 

Remedy analysis: Given the clear history of the Lyme Disease and subsequent to that the chronic joint pains and inflammation, a remedy from the Ericaceae family has to be considered, especially Ledum and Kalmia. (See the article An Overview on Lyme Disease and its correlation to the Ericaceae family.) Also it is stated that in that family, the mental picture includes a person who is soft, yielding and mild and sensitive to the needs of others, and quiet and practical. All this could fit her case.

In her history, she tended to have occasional severe abdominal pains in the abdomen, from the age of 12. This keynote plus her general nature and having issues of self identity and being overcontrolled by her father from a young age makes a consideration of Carcinosin a consideration.

Looking at constitutional features, including her body type and personality, one would have to consider Silicea and also Pulsatilla.

Rx: Ledum was chosen in this case and was given over a period of 10 months, approximately one dose every 8 weeks, of 200c for 5 times and Ledum 1m 3 times. She improved considerably on this remedy and her symptoms were over 60% >.

However, one very strong symptom remained, which was a strong fear of being knocked into, that something could hit her. She felt vulnerable to this happening, of being injured. Based on this and her history of being assaulted twice, Arnica was given, 30c and 200c over a 7 month period. All in all, in this time, she did well and the fear was mitigated to a large extent. 

When checking in with her then, it was clear that the relationship with her ex-husband was still not clear and they were still talking to one another very frequently, even though we had spoken about it and she had recognized that it wasn’t good to be so involved with him. Based on this and the preceding analysis, Pulsatilla was initially given but after further consideration, Silica was given, in a 30c for 3 doses, followed by a 200c dose, covering a 7 month period. Again, she did very well on this remedy and a cyst that had been growing on her back also got much better  from this remedy. By the end of this time, she was functionally normally and although still sensitive in some areas, having to be careful how much she did, she was pretty much free of pain, her energy was better and her mental state very good. 

That concluded the treatment of this case at the time, the whole period of case follow up being nearly 3 years. She had stopped the antibiotics a long time before but had taken one further dose when she got sick when traveling.

Reflection:

Overall, she did very well on remedies and she was much better in all ways. A question of whether Silica would have dealt with all the symptoms from the beginning could be made, if this was her constitutional remedy. This question can not be answered emphatically as both remedies worked well and after the Silica, she didn’t have a return of the symptoms that the Ledum helped, which sometimes happens when the 1st remedy is only palliative.  A case can be made that Ledum was the remedy for the Lyme etiology and consequent symptoms but Silica was needed to address underlying issues.

Unfortunately Carcinosin was not given in this case, even though considered. On reflection, this remedy should have been given at some point in the treatment.